The Kidney Allocation System from the Perspective of a Small Program in a Donor Service Area

K. Brown,² S. Hill,² L. Lipscomb,² A. Jones,² S. Hanna,² J. Africa.¹

¹Glickman Institute, Cleveland Clinic, Cleveland, OH
²Urology and Renal Transplant, Charleston Area Medical Center, Charleston, WV.

Meeting: 2018 American Transplant Congress

Abstract number: B83

Keywords: Allocation, Donors, marginal, Public policy, Resource utilization

Topic:

Session Information

Session Name: Poster Session B: Kidney Deceased Donor Allocation

Date: Sunday, June 3, 2018

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

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

Location: Hall 4EF

This study investigated the impact of the new kidney allocation system (KAS) on a small transplant program (SP) when compared with the 3 other centers (OC) in the same donor service area (DSA) in region 2. The hypothesis was that the KAS negatively affected SP by transplanting more marginal donors as compared to OC.

Methods. This retrospective review of the SRTR data (1/1/2013-12/31/2014 [pre-KAS] and 1/1/2015-12/31/2016 [KAS]) compared SP versus OC on the following variables: donor age>65, ECD, ischemia times; recipient age>65, PRA>80, BMI>30, and DGF. Cochran-Mantel-Haenszel Statistics was used for analysis.

Results. SP performed fewer transplants, while all 3 OCs did more, after the KAS change. SP accepted older and more ECD donors pre-KAS; after KAS this remained significant. Ischemia has significantly become longer for SP with KAS. More obese patients were transplanted by SP, while OC did more PRA>80. Interestingly, DGF was worse for OC.

	pre-KAS		Pvalue	KAS		Pvalue	Overall Pvalue⁺
	SP(n=73)	OC (n=383)		SP(n=55)	OC(n=503)
DONOR
Age>65	7(10%)	8(2%)	0.0001	6(11%)	10(2%)	0.0002	<.0001
ECD	15(21%)	43(11%)	0.0285	17(31%)	75(15%)	0.002	0.0002
Ischemia 0-11	34(46%)	128(47%)	NS	7(14%)	297(61%)	<.0001	<.0001
Ischemia 12-21	33(45%)	129(47%)		31(62%)	164(34%)
Ischemia over 22 hours	7(10%)	18(7%)		12(24%)	25(5%)
RECIPIENT
Age>65	12(16%)	120(31%)	0.0427	12(22%)	123(24%)	NS	NS
PRA>80	7(10%)	98(26%)	0.0029	7(10%)	123(24%)	NS	0.0225
BMI>30	29(40%)	127(33%)	NS	25(45%)	157(31%)	0.0324	0.0258
DGF	8(11%)	87(23%)	0.0234	7(13%)	126(25%)	0.0417	0.0023
⁺Summary statistics for center by variables controlling for KAS (pre-KAS vs changes with KAS) using Cochran-Mantel-Haenszel Statistics.

Conclusion. The KAS negatively affected a small, isolated transplant program by accepting higher risk donors with longer ischemia times. When compared with OC in a common DSA, this inequity became even more obvious.

CITATION INFORMATION: Brown K., Hill S., Lipscomb L., Jones A., Hanna S., Africa J. The Kidney Allocation System from the Perspective of a Small Program in a Donor Service Area Am J Transplant. 2017;17 (suppl 3).

To cite this abstract in AMA style:

Brown K, Hill S, Lipscomb L, Jones A, Hanna S, Africa J. The Kidney Allocation System from the Perspective of a Small Program in a Donor Service Area [abstract]. https://atcmeetingabstracts.com/abstract/the-kidney-allocation-system-from-the-perspective-of-a-small-program-in-a-donor-service-area/. Accessed June 15, 2021.

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