Impact of the new Kidney Allocation System (KAS) for CPRA >98% recipients on transplant laboratory operations – An opo perspective

Abstract

The new Kidney Allocation System (KAS) implemented on December 4, 2014 was developed to improve the discard rates of kidneys, give patients with extensive wait time and high Panel Reactive Antibody (PRA) access to transplantation and improve re-transplant rates. Under the new system, highly sensitized patients are given priority by allowing additional points for candidates with Calculated Panel Reactive Antibody (CPRA) >98% thus enabling them to receive regional and national priority kidney offers. The NJ Sharing Network (NJSN) is an organ procurement organization equipped with a transplant laboratory. This study evaluated the impact of the new KAS on NJSN’s transplant laboratory operations by measuring the number of (1) deceased donor (DD) crossmatches, (2) recipients transplanted, (3) blood samples shipped after the new KAS was implemented, and (4) kidneys discarded, and compared them to the same parameters prior to the KAS implementation. More crossmatches were performed on import DD than local DD. The percentage of imported DD that were crossmatched with recipients was 58% between December 4, 2014 and April 2, 2015 as compared to 22% during the same timeframe the prior year. The number of virtual crossmatches performed increased significantly after implementation of the new KAS. There were 21 patients with CPRAs over 98% who received a kidney transplant between December 19, 2014 and May 1, 2015. Of the 21 transplanted organs, only 4 were from local DD, the remaining were import donors. There were 0 transplants from patients with CPRAs over 98% from the same timeframe the prior year. There were 22 DD kidney blood samples shipped to other transplant laboratories during the first quarter of 2015 as compared to 4 blood samples shipped during the same timeframe in 2014 resulting in a 5.5 fold increase. The 2015 year-to-date kidney discard rate is 24% as compared to 17% in 2014, and 10% in 2013. We observed (1) an increase of imported DD being crossmatched, (2) patients with CPRAs over 98% receiving transplants, (3) an increase in the number of blood samples being shipped to other transplant laboratories and (4) an increase in the number of kidneys being discarded.