OR33 Comparison of UCLA patients transplanted from the deceased donor waitlist during the new and previous UNOS kidney allocation systems

Abstract

Aim UNOS implemented a new kidney allocation system (New KAS) on December 4, 2014 with the goal of increasing patient and allograft post-transplant survival. We aimed to determine the effects of the New KAS on UCLA patients transplanted from the deceased donor waitlist in comparison to the previous allocation system (Previous KAS). Methods We evaluated isolated kidney transplants from the deceased donor waitlist during the first three months of the new KAS (12/4/2014–3/4/2015) and compared to the same time period during the Previous KAS (12/4/2013–3/4/2014). Demographic and clinical information were collected by reviewing the patient’s UNOS removal data and medical record. Information describing deceased donors were gathered from UNOS DonorNet. Results The total number of deceased donor isolated kidney transplants was increased in the New KAS as compared to the Previous KAS (42 vs 26). Transplant of regraft patients and of highly sensitized patients with cPRA ⩾98% was also significantly increased (New KAS vs Previous KAS, 42.9% vs 11.5%, p ⩽ 0.007, and 31.0% vs 0.0%, p ⩽ 0.001, respectively). In the New KAS, the percentage of patient’s receiving allografts imported from outside our local area was increased (33.3 vs 19.2). Imported organs were allocated either to very highly sensitized ⩾ 99% cPRA) patients receiving a second transplant (71.4%) or had very high KDPI and were allocated to patients with 0% cPRA (21.4%). Recipients and donors with age differences exceeding 15 years was decreased in the New KAS as compared to the Previous KAS (50.0 vs 29.0%, p ⩽ 0.12). There was a 76% reduction in transplant to patients in the 65 + age group in the New KAS ( p ⩽ 0.016). We have not observed a paucity in transplant of pediatric patients (0–17 years, New KAS vs Previous KAS, 9.5% vs 3.8%, respectively). The percentage of patients transplanted with preformed donor specific antibody (DSA) is increased in the New KAS in comparison to the Previous KAS (33.3 vs 15.4%, respectively). Outcome measures will be evaluated after 3 months follow up. Conclusion The data show that the New KAS is working as designed to better age match recipients and donors and to increase transplantation of very highly sensitized patients through broader sharing.