title: Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation.
abstract: After over a decade of discussion, analysis, and consensus-building, a new kidney allocation system (KAS) was implemented on December 4, 2014. Key goals included improving longevity matching between donor kidneys and recipients and broadening access for historically disadvantaged subpopulations, in particular highly sensitized patients and those with an extended duration on dialysis but delayed referral for transplantation. To evaluate the early impact of KAS, we compared Organ Procurement and Transplantation Network data 1 year before versus after implementation. The distribution of transplants across many recipient characteristics has changed markedly and suggests that in many ways the new policy is achieving its goals. Transplants in which the donor and recipient age differed by more than 30 years declined by 23%. Initial, sharp increases in transplants were observed for Calculated Panel-Reactive Antibody 99-100% recipients and recipients with at least 10 years on dialysis, with a subsequent tapering of transplants to these groups suggesting bolus effects. Although KAS has arguably increased fairness in allocation, the potential costs of broadening access must be considered. Kidneys are more often being shipped over long distances, leading to increased cold ischemic times. Delayed graft function rates have increased, but 6-month graft survival rates have not changed significantly.
authors.affiliation: Research Department, United Network for Organ Sharing, Richmond, VA.
authors.forename: D E
authors.identifier: 0000-0002-6764-4842
authors.initials: DE
authors.lastname: Stewart
authors.affiliation: Research Department, United Network for Organ Sharing, Richmond, VA.
authors.forename: A Y
authors.initials: AY
authors.lastname: Kucheryavaya
authors.affiliation: Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, VA.
authors.forename: D K
authors.identifier: 0000-0001-5764-0664
authors.initials: DK
authors.lastname: Klassen
authors.affiliation: Department of Surgery, Emory University, Atlanta, GA.
authors.forename: N A
authors.initials: NA
authors.lastname: Turgeon
authors.affiliation: Department of Medicine and Surgery, Yale School of Medicine, New Haven, CT.
authors.forename: R N
authors.initials: RN
authors.lastname: Formica
authors.affiliation: Department of Surgery, University Hospitals Case Medical Center, Cleveland, OH.
authors.forename: M I
authors.initials: MI
authors.lastname: Aeder
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D051799:Delayed Graft Function / Q000453:epidemiology*; D046148:Donor Selection; D005260:Female; D033161:Government Regulation; D006085:Graft Survival; D006284:Health Plan Implementation; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013997:Time Factors; D014019:Tissue Donors / Q000600:supply & distribution*; D009927:Tissue and Organ Procurement / Q000331:legislation & jurisprudence* / Q000379:methods*; D014481:United States / Q000453:epidemiology; D055815:Young Adult