Multilisting Practices and Outcomes for Deceased Donor Kidney Transplants After Implementation of Distance-Based...

Area of Science:

• Nephrology
• Transplantation
• Health Policy

Background:

• Candidates for kidney transplants in the U.S. can join waitlists at multiple centers to enhance transplant chances.
• A new distance-based kidney allocation system (KAS250) was introduced in March 2021, promoting wider organ sharing and potentially altering the advantages of multilisting.

Purpose of the Study:

• To determine if the incidence and geographic distribution of multilisting changed following the implementation of KAS250.
• To assess the impact of multilisting on kidney transplant rates before and after KAS250.

Main Methods:

• Analysis of national registry data for adult kidney transplant candidates waitlisted before (KAS) and after (KAS250) the system change.
• Comparison of multilisting proportions, transplant incidence, and geographic patterns between the two eras.

Main Results:

• The proportion of multilisted candidates remained similar (9.5% vs. 9.3%).
• Multilisting significantly increased two-year transplant incidence in both KAS and KAS250 (HR 2.02, 2.51).
• Candidates multilisted at centers >250 NM apart had higher transplant incidence; geographic patterns shifted modestly post-KAS250.

Conclusions:

• Multilisting practices have slightly shifted post-KAS250 but continue to provide a substantial benefit for transplant receipt.
• Ongoing policy discussions are needed to balance candidate choice in multilisting with equitable organ allocation.