New priorities: Analysis of the New Kidney Allocation System on UCLA patients transplanted from the deceased donor waitlist.
UNOS implemented a new Kidney Allocation System (New KAS) on December 4, 2014 with a primary goal of increasing equity to organ transplant for patients that were immunologically or socially disadvantaged by the previous allocation system (Previous KAS) that prioritized long wait times. We examined the effects of the New KAS on patients transplanted from the UCLA deceased donor waitlist during the first year and compared to the last year of the Previous KAS. The total number of deceased donor kidney transplants was increased in the New KAS as compared to the Previous KAS (178 vs 148). Transplant of regraft patients and of highly sensitized patients with cPRA⩾99% was significantly increased in the New KAS (New KAS vs Previous KAS, 29.8% vs 11.5%, p⩽0.0001, and 26.4% vs 2.7%, p⩽0.0001, respectively). In the New KAS, the percentage of patient's receiving allografts imported from outside our local area was also significantly increased (34.8% vs 15.5%, p<0.0001). In the New KAS, 59.7% and 48.3% of imported organs were allocated to very highly sensitized (⩾99% cPRA) or re-graft patients, respectively, as compared to 8.7% and 8.7% during the Previous KAS (p<0.001). Recipients and donors with age differences exceeding 15years were decreased in the New KAS as compared to the Previous KAS (36.5 vs 48.7%, p⩽0.032). There was a 40.1% reduction in transplant to patients in the 65+ age group in the New KAS (p⩽0.025). The percentage of patients transplanted with preformed donor specific antibody (DSA) was similar in the New as compared to the Previous KAS (19.7% vs 15.5%) and, patients were transplanted with a range of 1-3 preformed DSA of weak to moderate strength. Cold ischemic time was significantly increased over all organs, and in patients transplanted with preformed DSA during the New as compared to the Previous KAS (17.5 vs 19.1h and 17.2 vs 22.2, p<0.04 and p<0.03, respectively). Episodes of delayed graft function and the number of biopsies for cause were similar between the New and the Previous KAS. However, there were more events of biopsy proven antibody mediated rejection in patients transplanted since the start of the New KAS. The data show that the New KAS is working at the center level as designed to better age match recipients and donors and to increase transplantation of very highly sensitized patients through broader sharing.
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA. Electronic address: mhickey@mednet.ucla.edu.
Michelle J
MJ
Hickey
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
Ying
Y
Zheng
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
Nicole
N
Valenzuela
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
Qiuheng
Q
Zhang
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
Carolyn
C
Krystal
Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
Erik
E
Lum
Department of Pediatrics, Division of Nephrology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
Eileen W
EW
Tsai
Department of Surgery, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; Department of Urology, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA; Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
Gerald S
GS
Lipshutz
Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
H Albin
HA
Gritsch
Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
Gabriel
G
Danovitch
Department of Medicine, David Geffen School of Medicine at UCLA, University of California, Los Angeles, CA, USA.
Jeffrey
J
Veale
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
David
D
Gjertson
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
Michael
M
Cecka
UCLA Immunogenetics Center, Department of Pathology and Laboratory Medicine, University of California, Los Angeles, CA, USA.
Elaine F
EF
Reed
D000046:Academic Medical Centers; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002102:Cadaver; D002648:Child; D002675:Child, Preschool; D002985:Clinical Protocols; D005260:Female; D033161:Government Regulation; D006680:HLA Antigens / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000378:metabolism; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D014019:Tissue Donors; D009927:Tissue and Organ Procurement; D066027:Transplant Recipients; D014481:United States; D014850:Waiting Lists; D055815:Young Adult
D006680:HLA Antigens; D007518:Isoantibodies
Donor specific antibody; Kidney Allocation System; Renal; Transplant; UNOS