New Kidney Allocation System: Friend or Foe?

F. Cabeza,² A. Dejman,¹ A. Torres,³ J. Gaynor,² P. Ruiz,² D. Roth,² W. Kupin,² G. Burke,² G. Ciancio,² L. Chen,² R. Vianna,² A. Mattiazzi,² G. Guerra.²

¹Nephrology and Hypertension, University of Miami, Miami, FL
²Kidney Transplant, Miami Transplant Institute, Miami, FL
³Internal Medicine, Hospital San Jose Tec de Monterrey, Mexico D.F., Mexico.

Meeting: 2016 American Transplant Congress

Abstract number: C84

Keywords: Allocation, Graft function, Kidney transplantation, Outcome

Session Information

Session Name: Poster Session C: Economics, Public Policy, Allocation, Ethics

Session Type: Poster Session

Date: Monday, June 13, 2016

Session Time: 6:00pm-7:00pm

Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

BACKGROUND

The new kidney allocation (KAS) system was implemented 12/2014 to increase recipient life years gained annually and facilitate the transplantation of harder to match recipients. At this large center, we compared the early impact of the new KAS to prior transplanted recipients.

METHODS

We performed a retrospective analysis of 269 patients from 1/1/2013-4/30/2015; 190 pre KAS (control group= C) vs 79 recipients (new KAS group= KAS). Pearson (uncorrected) chi-squared tests of association were done between selected baseline variables and group status (C vs. KAS) as well as between group status and selected outcome variables (% delayed graft function, DGF, %biopsy proven acute rejection, BPAR).

RESULTS: Mean age of 52.6 years for both groups, p=0.12; male gender was 60% KAS vs. 56% C; 71% (56/79) of KAS were African-Americans vs. 45.8% (87/190) in C (p=0.0002). Dialysis time >10 years was 12% (23/190) in C vs. 41% (32/79) in KAS (p< 0.000001). No statistical differences on KDPI score resulted between groups.

Outcomes: 6.3% (5/79) highly sensitized patients with >99% cPRA had national priority in KAS vs. 2.6% (5/190) in C group, P=0.09. However only 2.5% (2/79) of the 95-98% cPRA local/regional priority patients were transplanted in KAS vs. 4.2% (8/190) in C (p = 0.9). The frequency of BPAR between groups were similar, 20.5% (39/190) in KAS vs. 19.0% (15/79) in C (p =0.77).

Imported kidneys represented 32.9% of KAS (26/79) vs. 12.1% (23/190) C (P=.00006); yet, cold ischemia time (CIT) was higher in the C rather than the KAS arm: CIT >30hrs: 22.8% (18/79) in KAS vs 56.3% (107/190) in C, p= 0.000001. Recipients received more donation after cardiac death (DCD) kidneys with KAS, 16.5% (13/79) vs 3.2% (6/190) C; correlating with increased DGF, 32.9% (26/79) vs. 11.1% (21/190) respectively, (P=.00002).

CONCLUSION

The analysis of KAS at our center mimics what occurs nationwide; however certain variables: prolonged time on dialysis, greater CIT and use of DCD may adversely impact graft outcomes over time requiring long-term analysis. We had three times the increase in DGF leading to greater economic burden. Large transplant centers are absorbing the bulk of higher risk patients favored by the new KAS policies.

CITATION INFORMATION: Cabeza F, Dejman A, Torres A, Gaynor J, Ruiz P, Roth D, Kupin W, Burke G, Ciancio G, Chen L, Vianna R, Mattiazzi A, Guerra G. New Kidney Allocation System: Friend or Foe? Am J Transplant. 2016;16 (suppl 3).

To cite this abstract in AMA style:

Cabeza F, Dejman A, Torres A, Gaynor J, Ruiz P, Roth D, Kupin W, Burke G, Ciancio G, Chen L, Vianna R, Mattiazzi A, Guerra G. New Kidney Allocation System: Friend or Foe? [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/new-kidney-allocation-system-friend-or-foe/. Accessed November 22, 2024.

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