Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation

Area of Science:

• Nephrology
• Transplantation immunology
• Public health policy

Background:

• A new kidney allocation system (KAS) was implemented in 2014 after extensive deliberation.
• The KAS aimed to enhance donor-recipient longevity matching and expand access for underserved groups, including highly sensitized patients and those with prolonged dialysis duration and delayed transplant referral.

Purpose of the Study:

• To assess the initial effects of the new kidney allocation system (KAS) on kidney transplant distribution and outcomes.
• To compare transplant data from the year preceding and the year following KAS implementation.

Main Methods:

• Analysis of Organ Procurement and Transplantation Network (OPTN) data.
• Comparison of kidney transplant recipient characteristics and outcomes before and after December 4, 2014.

Main Results:

• Significant shifts in transplant distribution were observed, indicating KAS is meeting some goals.
• A 23% reduction in transplants with >30-year age differences between donor and recipient.
• Increased initial transplants for highly sensitized patients (99-100% CPRA) and those with ≥10 years on dialysis, suggesting a 'bolus effect'.

Conclusions:

• The KAS appears to have increased fairness in kidney allocation.
• Broader access under KAS has led to increased kidney transport distances and cold ischemic times.
• While delayed graft function has risen, 6-month graft survival rates remain stable.