The Impact of the New Kidney Allocation System on Living Donor Kidney Transplantation(LDTX) Among Patients in the Lowest Quintile of Expected Post-Transplant Survival (EPTS).
Division of Nephrology, University of British Columbia, Vancouver, Canada
Meeting: 2017 American Transplant Congress
Abstract number: D292
Keywords: Allocation, Donation
Session Information
Session Name: Poster Session D: Non-Organ Specific: Economics, Public Policy, Allocation, Ethics
Session Type: Poster Session
Date: Tuesday, May 2, 2017
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall D1
Background: Changes in deceased donor allocation policy may impact LDTX.
The prioritization of patients in the top 20% of EPTS to receive deceased donor kidneys in the lowest quintile of the kidney donor profile index (KDPI) in the new kidney allocation system (KAS) has the potential to decrease pursuit of LDTX in these patients. Using data from UNOS we determined changes in the rate of transplantation per 100 years of wait-listing among top 20% EPTS candidates, as well as changes in KDPI and HLA matching in top 20% EPTS recipients in the year before and after implementation of KAS in Dec 2014.
The Table shows the overall increase in transplantation per 100 patient years in this group was due to an increase in deceased donor transplantation(DDTX) but there was a slight drop in LDTX. This pattern was consistent in sub-groups defined by recipient race, gender and diabetic status. There was a slight decrease in the KDPI of kidneys transplanted into EPTS top 20% patients post-KAS (median (Q1,Q3) KDPI 19% (8% to 37%) compared to pre-KAS (KDPI:22% (7%,42%)). (Note: LDKDPI used for recipients of LDTX.) In addition, the percent of 0 HLA-MM kidney transplantation decreased post-KAS by 31% (from 6.7-4.6%).
| PRE KAS | POST KAS | |
| Oveall Transplant Rate per 100 patient Years | 21.4 | 25.8 |
| Deceased Donor Rates | ||
| All | 11.3 | 15.3 |
| Black | 10.1 | 15.1 |
| Non-Black | 12.0 | 15.4 |
| Male | 11.3 | 15.3 |
| Female | 11.3 | 15.3 |
| Diabetic | 14.1 | 16.1 |
| Non-Diabetic | 11.1 | 15.3 |
| Living Donor Rates | ||
| All | 10.9 | 10.5 |
| Black | 3.6 | 3.5 |
| Non-Black | 15.4 | 14.5 |
| Male | 11.3 | 11.1 |
| Female | 10.4 | 9.7 |
| Diabetic | 7.1 | 6.3 |
| Non-Diabetic | 11.1 | 10.7 |
We conclude that although the overall rate of kidney transplantation has increased, the rate of LDTX has declined in top 20% EPTS patients and there has been only a modest improvement in the overall KDPI of kidneys transplanted in these patients and there was a decline in the HLA matching of top 20% EPTS patients post KAS. Dedicated strategies to promote LDTX in this group of patients are needed to ensure excellent long-term outcomes in this patient group.
CITATION INFORMATION: Rose C, Gill J, Lesage J, Joffres Y, Gill J. The Impact of the New Kidney Allocation System on Living Donor Kidney Transplantation(LDTX) Among Patients in the Lowest Quintile of Expected Post-Transplant Survival (EPTS). Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Rose C, Gill J, Lesage J, Joffres Y, Gill J. The Impact of the New Kidney Allocation System on Living Donor Kidney Transplantation(LDTX) Among Patients in the Lowest Quintile of Expected Post-Transplant Survival (EPTS). [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/the-impact-of-the-new-kidney-allocation-system-on-living-donor-kidney-transplantationldtx-among-patients-in-the-lowest-quintile-of-expected-post-transplant-survival-epts/. Accessed May 13, 2025.« Back to 2017 American Transplant Congress