title: Early Changes in Kidney Distribution under the New Allocation System.
abstract: The Kidney Allocation System (KAS), a major change to deceased donor kidney allocation, was implemented in December 2014. Goals of KAS included directing the highest-quality organs to younger/healthier recipients and increasing access to deceased donor kidney transplantation (DDKT) for highly sensitized patients and racial/ethnic minorities. Using national registry data, we compared kidney distribution, DDKT rates for waitlist registrants, and recipient characteristics between January 1, 2013, and December 3, 2014 (pre-KAS) with those between December 4, 2014, and August 31, 2015 (post-KAS). Regional imports increased from 8.8% pre-KAS to 12.5% post-KAS; national imports increased from 12.7% pre-KAS to 19.1% post-KAS (P<0.001). The proportion of recipients >30 years older than their donor decreased from 19.4% to 15.0% (P<0.001). The proportion of recipients with calculated panel-reactive antibody =100 increased from 1.0% to 10.3% (P<0.001). Overall DDKT rate did not change as modeled using exponential regression adjusting for candidate characteristics (P=0.07). However, DDKT rate (incidence rate ratio, 95% confidence interval) increased for black (1.19; 1.13 to 1.25) and Hispanic (1.13; 1.05 to 1.20) candidates and for candidates aged 18-40 (1.47; 1.38 to 1.57), but declined for candidates aged >50 (0.93; 0.87 to 0.98 for aged 51-60 and 0.90; 0.85 to 0.96 for aged >70). Delayed graft function in transplant recipients increased from 24.8% pre-KAS to 29.9% post-KAS (P<0.001). Thus, in the first 9 months under KAS, access to DDKT improved for minorities, younger candidates, and highly sensitized patients, but declined for older candidates. Delayed graft function increased substantially, possibly suggesting poorer long-term outcomes.
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland;
authors.forename: Allan B
authors.initials: AB
authors.lastname: Massie
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors.forename: Xun
authors.initials: X
authors.lastname: Luo
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors.forename: Bonnie E
authors.initials: BE
authors.lastname: Lonze
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
authors.forename: Niraj M
authors.initials: NM
authors.lastname: Desai
authors.affiliation: Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, Texas;
authors.forename: Adam W
authors.initials: AW
authors.lastname: Bingaman
authors.affiliation: Medstar Georgetown Transplant Institute, Georgetown University, Washington, DC; and.
authors.forename: Matthew
authors.initials: M
authors.lastname: Cooper
authors.affiliation: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland; Scientific Registry for Transplant Recipients, Minneapolis, Minnesota dorry@jhmi.edu.
authors.forename: Dorry L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D009927:Tissue and Organ Procurement / Q000458:organization & administration* / Q000706:statistics & numerical data*; D055815:Young Adult
keywords: chronic kidney disease; transplant outcomes; transplantation