Abstract: SA-PO060
Disproportionate Allocation of High Quality Kidneys to Highly Sensitized Recipients in the New Kidney Allocation System Despite a Limited “Bolus Effect”
Session Information
- Transplantation: Recipient and Donor Assessment
October 27, 2018 | Location: Exhibit Hall, San Diego Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 1802 Transplantation: Clinical
Authors
- Bakhtiyar, Syed shahyan, Baylor College of Medicine, Houston, Texas, United States
- Rana, Abbas, Baylor College of Medicine, Houston, Texas, United States
- Dave, Natasha Naresh, Baylor College of Medicine, Houston, Texas, United States
- Kueht, Michael, Baylor College of Medicine, Houston, Texas, United States
- Goss, John A., Baylor College of Medicine, Houston, Texas, United States
- Murthy, Bhamidipati V.R., Baylor College of Medicine, Houston, Texas, United States
Background
The 2014 Kidney Allocation System (KAS) aims to minimize death with functioning grafts, and increase transplantation rates among highly sensitized patients (PRA≥98%). We examined if preferential allocation to high PRA patients results in disproportionate allocation of high quality kidneys (Kidney Donor Performance Index < 0.2) to these patients, and if a “bolus effect” dissipates the allocation over time.
Methods
Using the UNOS data, kidney transplantations from the start of the new system 12/4/2014-12/31/17 (study group) were compared with those for two preceding years - 12/4/2012-12/3/2014 (control group) for pre- and post-transplant characteristics, and overall graft and patient survival.
Results
Excluding living donors (n=28,785) and multi-organ transplants (n=8,896), there were 37,933 recipients in study group, and 21,412 in control group. One year patient and graft survival in the study versus the control group were 96.8% vs 96.9% (p<0.0001) and 94.4% vs 94.2% (p<0.0001) respectively. In the study group, 4,564(12%) high PRA patients were transplanted, compared to 704(3.3%) in the control group. 1,384/8,180 (16.9%) of high quality kidneys in the study group were received by high PRA patients, compared to 181/4,542 (4%) in the control; four-monthly analysis of the study group shows that high PRA recipients of these kidneys decreased from 116/532 (21.8%) in December 2014–March 2015 to 122/936 (13.03%) in September–December 2017. Among these high PRA recipients of high quality kidneys, there was no difference in one year patient (98% vs 96.1%, p=0.8) and graft survival (96.6% vs 92.2%, p=0.5) between the study and control group respectively.
Conclusion
Despite a decreased trend in high quality kidney allocation to high PRA patients in the new system over time, it is still significantly higher than in the old system. Thus, any bolus effect is only partial. While there is no difference in patient and graft survival in this cohort, follow-up may be too short to show a difference. As such, a national policy may be needed to optimize this allocation in the new KAS.