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J Am Soc Nephrol. 2016 Aug;27(8):2495-501. doi: 10.1681/ASN.2015080934. Epub 2015 Dec 17.

Early Changes in Kidney Distribution under the New Allocation System.

Author information

1
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland;
2
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland;
3
Texas Transplant Institute, Methodist Specialty and Transplant Hospital, San Antonio, Texas;
4
Medstar Georgetown Transplant Institute, Georgetown University, Washington, DC; and.
5
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.

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.

KEYWORDS:

chronic kidney disease; transplant outcomes; transplantation

PMID:
26677865
PMCID:
PMC4978057
DOI:
10.1681/ASN.2015080934
[Indexed for MEDLINE]
Free PMC Article

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