Date: Sunday, June 2, 2019
Session Time: 2:30pm-4:00pm
Presentation Time: 3:30pm-3:42pm
Location: Ballroom C
*Purpose: Kidney transplant (KTx) utilization of moderate to high KDPI (MH-KDPI) deceased donor kidneys remains an opportunity to reduce organ discards. We participated in COIIN, a 3 yr HRSA funded, OPTN/UNOS-lead sponsored pilot project to increase utilization of kidneys with KDPI >50%.
*Methods: 19 KTx centers were enrolled for this pilot (cohort A). We report the findings from our single center. Baseline clinical characteristics for KTx waitlist and recipients, organ acceptance characteristics and outcomes from 1/1/16-9/30/16 (pre) were compared to outcomes after interventions, 1/1/17-9/1/17 (post-COIIN) at our center, cohort A (CoA) and the nation (US). Multiple collaborative learning sessions between centers were held throughout this project. Root analysis based on baseline COIIN data resulted in 3 formal PDSA projects enacted at our center to address opportunities: 1) low consent rates for high KDPI organs 2) education knowledge gaps by staff and referring physicians about KDPI 3) organ acceptance rates. Over 50 individual teaching sessions with referring nephrologists and internal staff were held regarding the new kidney allocation system (KAS) and KDPI. Center specific and COIIN generated, national peer comparison data was shared with the transplant team to address opportunities to improve.
*Results: Compared to baseline (pre) overall transplant volume increased (post-COIIN) by 43% (82 vs 111 KTx). KTx of MH-KDPI increased significantly 124% (25 vs 56), p =0.014. This was substantially higher than CoA and US, 14 and 3% respectively. Organ offer acceptance rates for KDPI 51-85 increased 140%, 11.8 vs 28.3, p<0.004 (pre vs post-COIIN) while KPDI >85 increased from 8.3 to 18.7, 125% vs 18 and 6% for CoA and US respectively. All transplant candidates were educated regarding MH-KDPI prior to listing. Wait list consent rates for patients with EPTS 21-79 increased from 7.2 to 23.4% p <0.001 (225% increase), pre vs post-COIIN, compared to 1% change in CoA and US. Median length of stay remained overall stable and in KDPI >85 actually declined 7.5 to 6.0 days (pre vs post). Cold ischemia time did not change overall 13.7 vs 13.3 hr (KDPI 51-100) or in KPDI >85, 14.8 vs 14.2 hr, pre vs post-COIIN. Delayed graft function (DGF) was unchanged overall in MH-KDPI or KDPI >85, 29 vs 25%, p>0.05. Overall graft survival remained excellent pre vs post at 6 mos 96.3 vs 96.6,% and 12 mos 96.3 vs 95.7%, all p>0.05.
*Conclusions: Utilizing a multi-operational approach, a collaborative, data driven process can significantly increase moderate to high KDPI kidney transplant rates. Formal education of patients, referring nephrologists, and staff regarding KAS and KDPI are essential. Increased utilization of MH-KDPI KTx can be performed with excellent outcomes
To cite this abstract in AMA style:Pesavento T, Foutz J, Sisaithong K, Klassen D, Stillion L, Rajab A, Pelletier R, Washburn K, Tosoc-Haskell H. Significant Increase in Moderate to High KDPI Kidney Transplants Using a Multi-Operational Approach: Results from the COIIN (Collaborative Innovation and Improvement Network) Initiative [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/significant-increase-in-moderate-to-high-kdpi-kidney-transplants-using-a-multi-operational-approach-results-from-the-coiin-collaborative-innovation-and-improvement-network-initiative/. Accessed August 12, 2020.
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