AI Article Synopsis
- - The new kidney allocation system (KAS250), implemented in March 2021, replaced regional donation service areas with a model focusing on distance, influencing the logistics of kidney transplantation and leading to an increase in kidney imports from nonlocal organ procurement organizations (OPO).
- - A study comparing the first 9 months of KAS250 to a pre-KAS250 cohort revealed that while kidney discards did not change immediately, there was a significant upward trend in discards over time, along with an increase in cold ischemia time (CIT) for transplants.
- - The changes under KAS250 improved access for patients with high calculated panel reactive antibody (cPRA) levels and those on dialysis for more than
Article Abstract
Background: In March 2021, the United States implemented a new kidney allocation system (KAS250) for deceased donor kidney transplantation (DDKT), which eliminated the donation service area-based allocation and replaced it with a system on the basis of distance from donor hospital to transplant center within/outside a radius of 250 nautical miles. The effect of this policy on kidney discards and logistics is unknown.
Methods: We examined discards, donor-recipient characteristics, cold ischemia time (CIT), and delayed graft function (DGF) during the first 9 months of KAS250 compared with a pre-KAS250 cohort from the preceding 2 years. Changes in discards and CIT after the onset of COVID-19 and the implementation of KAS250 were evaluated using an interrupted time-series model. Changes in allocation practices (biopsy, machine perfusion, and virtual cross-match) were also evaluated.
Results: Post-KAS250 saw a two-fold increase in kidneys imported from nonlocal organ procurement organizations (OPO) and a higher proportion of recipients with calculated panel reactive antibody (cPRA) 81%-98% (12% versus 8%; P <0.001) and those with >5 years of pretransplant dialysis (35% versus 33%; P <0.001). CIT increased (mean 2 hours), including among local OPO kidneys. DGF was similar on adjusted analysis. Discards after KAS250 did not immediately change, but we observed a statistically significant increase over time that was independent of donor quality. Machine perfusion use decreased, whereas reliance on virtual cross-match increased, which was associated with shorter CIT.
Conclusions: Early trends after KAS250 show an increase in transplant access to patients with cPRA>80% and those with longer dialysis duration, but this was accompanied by an increase in CIT and a suggestion of worsening kidney discards.
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| http://www.ncbi.nlm.nih.gov/pmc/articles/PMC10101588 | PMC |
| http://dx.doi.org/10.1681/ASN.2022040471 | DOI Listing |
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