The Impact of the New Kidney Allocation System on Prior Living Kidney Donors' Access to Deceased Donor Kidney Transplants: An Early Look.
This study investigated the early effects of the new kidney allocation system (KAS) on the access of prior living kidney donors (PLDs) to deceased donor kidney transplants. Using data from the Organ Procurement and Transplantation Network, we compared prevalent and incident cohorts of PLDs in the 1-year periods before and after KAS implementation (pre-KAS group: December 4, 2013, to December 3, 2014, n = 50 [newly listed PLDs]; post-KAS group: December 4, 2014, to December 3, 2015, n = 39). We assessed transplant rates per active patient-year, waiting times, and Kidney Donor Profile Index (KDPI) of transplanted kidneys. Transplant rates were not statistically different before and after KAS implementation for either prevalent (2.37 vs. 2.29, relative risk [RR] 0.96; 95% confidence interval [CI] 0.62-1.49) or incident (4.76 vs. 4.36, RR 0.92; 95% CI 0.53-1.60) candidates. Median waiting time (MWT) to deceased donor kidney transplant for prevalent PLDs in the post-KAS cohort was 102.6 days compared with 82.3 days in the pre-KAS cohort (p = 0.98). The median KDPI for PLD recipients was 31% with KAS versus 23% before KAS (p = 0.02). Despite a sharp decrease in the MWT for highly prioritized candidates with calculated panel reactive antibodies of 98-100% (from >7000 to 1164 days), PLDs still had much shorter waiting times (MWT 102.6 days). The new system continues to provide quick access to high-quality organs for PLDs.
Research Department, United Network for Organ Sharing, Richmond, VA.
J L
JL
Wainright
Research Department, United Network for Organ Sharing, Richmond, VA.
A Y
AY
Kucheryavaya
Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, VA.
D K
0000-0001-5764-0664
DK
Klassen
Research Department, United Network for Organ Sharing, Richmond, VA.
D E
0000-0002-6764-4842
DE
Stewart
D000328:Adult; D000368:Aged; D064591:Allografts; D002102:Cadaver; D005260:Female; D006085:Graft Survival; D015276:Health Care Rationing; D006650:Histocompatibility Testing; D006801:Humans; D016031:Liver Transplantation / Q000401:mortality*; D019520:Living Donors; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015996:Survival Rate; D009927:Tissue and Organ Procurement / Q000379:methods*; D066027:Transplant Recipients; D016896:Treatment Outcome; D014850:Waiting Lists
clinical research/practice; donors and donation: living; kidney transplantation/nephrology; kidney transplantation: living donor