title: Old versus new: Progress in reaching the goals of the new kidney allocation system.
abstract: As demand for kidney transplant continues to grow faster than organ availability, appropriate allocation of deceased donor kidneys is an acute priority. Increased longevity matching is central to this effort. To foster equitable and efficient utilization of deceased donor kidneys, a new kidney allocation system (KAS) was introduced in December 2014. Major achievements in the 1year after its implementation include a reduction in age-mismatch and an increase in access to transplant for historically disadvantaged candidates, such as those with very high levels of panel-reactive antibodies or long dialysis duration. However, the rate of discarded kidneys has not decreased, and an increase in A2/A2B transplants has yet to be realized. Organs are now shared more often at the regional and national levels, with some regions experiencing an increase in transplants and other a decrease. While implementation of the KAS has been associated with the attainment of key goals, the kidney transplant community must remain vigilant about potential untoward consequences, including reductions in transplant rates for specific groups such as pediatric patients. More time is required before firm conclusions about the long-term effects of the new KAS can be rendered.
authors.affiliation: Division of Nephrology, Hennepin County Medical Center, University of Minnesota, 701 Park Avenue, Minneapolis, MN 55415, United States. Electronic address: connie.wang@hcmed.org.
authors.forename: Connie J
authors.initials: CJ
authors.lastname: Wang
authors.affiliation: Division of Nephrology, Hennepin County Medical Center, University of Minnesota, 701 Park Avenue, Minneapolis, MN 55415, United States. Electronic address: james.wetmore@hcmed.org.
authors.forename: James B
authors.initials: JB
authors.lastname: Wetmore
authors.affiliation: Division of Nephrology, Hennepin County Medical Center, University of Minnesota, 701 Park Avenue, Minneapolis, MN 55415, United States; Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, 701 Park Avenue, Suite S4.100, Minneapolis, MN 55415, United States. Electronic address: isran001@umn.edu.
authors.forename: Ajay K
authors.initials: AK
authors.lastname: Israni
mesh_terms: D046148:Donor Selection; D033161:Government Regulation; D006648:Histocompatibility; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies; D007519:Isoantigens; D016030:Kidney Transplantation; D012042:Registries; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D014481:United States; D014850:Waiting Lists
chemical_list: D007518:Isoantibodies; D007519:Isoantigens
keywords: Deceased donor kidney transplant; End-stage renal disease (ESRD); Estimated posttransplant survival (EPTS); Kidney donor profile index (KDPI); Kidney transplant; New kidney allocation system (KAS)