OR32 The new kidney allocation system disadvantages patients with cPRA 90–98% – A single center analysis

Abstract

Aim The new UNOS kidney allocation system (KAS) awards 212 points to renal transplant candidates (RTC) with cPRA of 99% or 100%, allowing for national sharing. We hypothesized that this might disadvantage RTC whose cPRA is high (⩾90%) but less than 99%. Methods We analyzed all import organ offers to RTC at our center for 5 months before and after the 12/4/14 change to the new KAS. We counted offers where the top RTC had cPRA of 90–98% or >98%. We compared number of offers, matchrun sequence number (MSN), HLA mismatch (MM), kidney donor profile index (KDPI), and transplants for these groups. Results On 12/4/14 there were 13 RTC with cPRA 90–98% and 24 with cPRA >98% on the active kidney waitlist. Comparisons of organ offers are shown in table 1. Pre-KAS there were 379 total kidney offers: 17.2% to RTC with cPRA 90–98% and 3.2% to cPRA >98%. Post-KAS about 13% of offers ( N = 419) went to each group ( p 2 ). Pre-KAS the MSN for offers to cPRA >98% RTC was higher by 680 places than for cPRA 90–98% RTC. Post-KAS the MSN for the cPRA 90–98% RTC was higher by about 925 places, giving them lower priority for offers and making them less likely to receive the organ even when provisionally accepted. The mean total HLA MM (A + B + DR) was significantly higher for 90–98% RTC than for >98% RTC pre-KAS. This difference between the two groups decreased after KAS but still remained significant. The mean KDPI of donor offers did not differ between the two groups before or after KAS implementation. The number of transplants of >98% RTC increased dramatically from 0 to 5 (all import) post-KAS but transplants of 90–98% RTC decreased from 3 (1 import, 2 local) to 2 (1 local, 1 transplanted elsewhere). Conclusions The new KAS has benefitted the >98% cPRA RTC waiting for kidneys by increasing the number of organs offered and transplanted. The organs offered pre- and post-KAS to this group were not significantly different in terms of HLA MM and KDPI. In contrast, the 90–98% cPRA group had fewer offers post-KAS and fewer transplants, but the offered kidneys were better HLA matched. Download full-size image