FIRST YEAR IMPACT OF THE NEW U.S. EXPANDED CRITERIA DONOR (ECD) KIDNEY ALLOCATION SYSTEM ON THE RECOVERY AND UTILIZATION OF ECD KIDNEYS

Abstract

O327* Aims: On 10/31/02, the United States Organ Procurement and Transplantation Network (OPTN) implemented a national policy that allocates expanded criteria donor (ECD) kidneys by waiting time alone. ECD kidneys were defined in previous studies as having a risk of graft failure that is 1.7 times greater than that of a reference population of nonhypertensive deceased-donors between the ages of 10 and 39 years, whose cause of death was not from cerebral vascular accident (CVA), and whose terminal creatinine was ≤1.5 mg/dl. ECDs include any donor >age 60 years and donors 50-59 years with any two of a terminal creatinine >1.5 mg/dl, a history of hypertension, or death by CVA. We assessed the impact of this innovation on the recovery and utilization of ECD kidneys. Methods: Using the Scientific Registry of Transplant Recipients (SRTR)/OPTN database, we compared the use of ECD kidneys recovered between 11/02 and 10/03 with kidneys meeting ECD criteria that were procured during a similar time period (11/01 through 10/02) in the year prior to ECD policy implementation. Differences were tested using t-test and Chi-square analyses. Results: Between 11/02 and 10/03, there was a 14.8% increase in ECD kidney recoveries and a 10.7% increase in ECD kidney transplants compared with the prior year. ECD kidneys made up 21.2% of all recovered kidneys and 16.0% of all transplants performed, compared with 18.9% (p<0.0001) and 14.6% (p=0.011), respectively, in the prior time period. The median relative risk for graft failure (based on ECD risk factors) for transplanted ECD kidneys increased from 1.99 to 2.16, while the median relative risk for procured ECD kidneys was unchanged at 2.16. ECD donors were >60 years old in 55.5% of cases. Conclusions: An increase in the number of kidney recoveries and transplants from ECD donors was observed under the newly introduced ECD allocation system. The use of pulsatile perfusion and the fraction of ECD kidneys with cold ischemia periods of less than 12 hours have increased significantly. Early analysis of ECD kidney utilization under this allocation policy supports its contination.Figure