P132 Improving pre-kidney transplantation laboratory utilization in an era of increasing waitlist size

Abstract

Aim Beginning on March 25, 2015, our institution’s kidney transplant program has implemented a “readiness” protocol, whereby patients are listed after limited workup and comprehensive testing is deferred until the anticipated time to transplantation is approximately 6–12 months. Prior to implementation of this protocol, our histocompatibility laboratory would receive monthly sera for anti-HLA antibody screening immediately upon listing. However, as part of the readiness strategy, the lab now requests monthly samples only when a candidate is predicted to have 6–12 months of waitlist time remaining. The monthly samples are stored and screened in the lab per protocol (every 3 months for most patients). All candidates are also screened once prior to listing and again immediately after listing. Methods Data from our laboratory database and UNOS were analyzed to determine the number of samples received from waitlisted kidney transplant candidates and the number tested in the three-year period before and after implementation of the readiness protocol. Results Our kidney transplant waitlist has grown from 379 candidates on 7/1/2012 to 948 as of 4/5/2018. Despite this rapid growth, the number of samples received from kidney transplant candidates has decreased from 9171 during the three-year period prior to the implementation of readiness (∼3057/year) to 7924 during the subsequent three-year period (∼2641/year). Based on a sample submission rate of ∼7 samples/patient/year, an estimated 4961 samples per year would have been received without the readiness protocol, with an estimated 6669 samples expected for 2018. From 3/25/12–3/24/15, 4730 antibody screening tests on kidney waitlist candidates were performed by Luminex (∼1577 tests/year), compared to a slight increase to 5082 from 3/25/15–3/24/18 (∼1694 tests/year), despite a 2.5-fold increase in patients on the waitlist from 2012–2018. Conclusions Implementation of the readiness protocol has streamlined the pre-transplant testing process and reduced both the number of samples received and the number tested. This has allowed us to manage a greatly increased waitlist with the same level of resources and has resulted in reduced cost per patient.