Introduction:The Organ Procurement and Transplantation Network (OPTN) has proposed a new national kidney allocation policy. Its important features include: allocating kidneys in the top twentieth percentile of the kidney donor profile index (KDPI) first to candidates in the top twentieth percentile of estimated posttransplant survival, then to remaining candidates; backdating wait time to the start of dialysis treatment; sliding scale CPRA points; broader sharing of kidneys for candidates with CPRA ≥98%; broader sharing of kidneys with KDPI ≥85%; elimination of the payback system; and A2 blood type kidneys allocated to blood type B candidates.
Methods: We simulated the distribution of kidney allografts based on the proposed allocation policy and compared the results with the current system and actual transplants in 2010 using publically available KPSAM software.
Results: The simulation under current allocation policy closely matched the distribution of 2010 kidneys. The new policy simulation showed increases in average projected median lifespan posttransplant, allograft years of life, and median lifespan increase adjusted for quality of life (LYFT) per transplant, compared with current policy.
|Average 10 Simulation Runs||Current Allocation Policy (min, max of runs)||New Allocation Policy (min, max of runs)|
|Number of Candidates (on waiting list at start or joining during run)||122,669||122,669|
|Average number of primary kidney and kidney pancreas transplants||11,531 (11,463-11,586)||11,365 (11,324-11,409)|
|Average median lifespan posttransplant||11.82 (11.75-11.85)||12.73 (12.65-12.79)|
|Average median graft years of life||8.82 (8.80-8.84)||9.10 (9.08-9.12)|
|Average median LYFT per transplant||5.70 (5.68-5.72)||5.97 (5.95-6.0)|
Distribution of kidneys did not change substantively by candidate race, HLA mismatches, or regional sharing. Candidates with CPRA ≥20% were more likely to receive offers under the new allocation policy than under current policy.
Conclusion: The new allocation policy can potentially improve outcomes posttransplant.
To cite this abstract in AMA style:Israni A, Gustafson S, Salkowski N, Lamb K, Friedewald J, Formica R, Snyder J, Kasiske B. New Proposed National Allocation Policy for Deceased Donor Kidneys in the U.S. and Its Possible Impact on Patient Outcomes [abstract]. Am J Transplant. 2013; 13 (suppl 5). https://atcmeetingabstracts.com/abstract/new-proposed-national-allocation-policy-for-deceased-donor-kidneys-in-the-u-s-and-its-possible-impact-on-patient-outcomes/. Accessed February 27, 2021.
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