Based on the first 4 months of post-KAS transplants

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Based on the first 4 months of post-KAS transplants
Kidney Transplantation
Committee
Spring 2016
1
Recent Public Comment Proposals
 OPTN



Kidney Paired Donation (KPD) Priority Points
Changes apply only to the OPTN KPD program
 Revisions to priority points (e.g. sliding scale for CPRA and donor/candidate
blood type)
 Remedy for candidates in a failed exchange
Board Approved: Dec. 2015
Implementation: Pending Programming
2
Policy Implementation Dates
 OPTN


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KPD Deadlines and Message Boards
Changes apply only to the OPTN KPD program
 Programs deadlines for:
 Match offer preliminary responses
 Performing crossmatches
 Providing and reviewing donor records
 Total time from offer to final acceptance/refusal = 15 business days
 Creates message boards for communication
Board Approved: June 2015
Estimated Implementation: Within 1st half of 2016
3
KAS Update
Spring 2016
4
Background

KAS implemented Dec 4, 2014

Key goals:

Make better use of available kidneys

Increase transplant opportunities for difficult-to-match patients (increased
equity)

Increase fairness by awarding waiting time points based on dialysis start date

Have minimal impact on most candidates
Background

Performance tracked monthly for first six months (“out of the gate” reports)

Comprehensive, 6-month analysis provided to the kidney committee in Sep 2015
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One year analysis requested by the committee (analyses underway)
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Pre-KAS period: Dec 4, 2013 – Dec 3, 2014 (12 months)
Post-KAS period: Dec 4, 2014 – Dec 3, 2015 (12 months)
Solitary, deceased donor kidney transplants
This slide set contains highlights from the full one-year report
Trends in kidneys recovered and transplanted
20,000
16,357
15,000
10,000
Kidneys
recovered for
transplant
15,408
↑ 6.2%
Solitary kidney
transplants
10,901
↑ 4.6%
11,397
5,000
0
Pre-KAS (Dec 4, 2013 - Dec 3, 2014)

Post-KAS (Dec 4, 2014 - Dec 3, 2015)
Nearly 1,000 more deceased donor kidneys were recovered postKAS, and nearly 500 more transplants occurred.
Who’s getting transplanted under KAS?
Percentage of Deceased Donor Kidney Transplants by Recipient Age

More young candidates (18-49) are receiving kidney transplants.

Transplants to pediatrics rebounded in 2nd six months
Who’s getting transplanted under KAS?
Percentage of Deceased Donor Kidney Transplants by Recipient Race/ethnicity

More African Americans are receiving kidney transplants, although
less so during the 2nd six months.
Who’s getting transplanted under KAS?
Percentage of Deceased Donor Kidney Transplants by Recipient Blood Type

The distribution of transplants has changed little by recipient ABO.

Slight increases for blood type B and AB patients.
Who’s getting transplanted under KAS?
Percentage of Deceased Donor Kidney Transplants by Recipient CPRA

Transplants increased sharply for CPRA 99-100% patients but have
tapered during the 2nd six months.
Who’s getting transplanted under KAS?
Percentage of Deceased Donor Kidney Transplants by Recipient Duration on Dialysis

More transplants are going to long dialysis duration recipients.

Fewer preemptive (before dialysis) transplants.
Geographic distribution of kidney transplants
21.4%
Pre-KAS (1 year)
Post-KAS (1 year)
31.5%
8.8%
12.6%
18.8%
12.7%
68.5%
78.6%
Local
Regional
National
Local
Regional
National

More kidneys are being distributed outside recovery OPO’s DSA.

CIT>24 hours: Pre-KAS 18.2%, Post-KAS 21.6%.
Geographic distribution of kidney transplants

The distribution of transplants by OPTN region has changed little.
Kidney recovery under KAS
Percentage of Recovered Deceased Kidney Donors by KDPI
60%
Pre-KAS (1-year)
52.4% 51.2%
Post-KAS (1-year)
40%
20%
19.2% 20.4%
14.3% 14.1%
14.1% 14.3%
0%
0-20
21-34
35-85
86-100
KDPI

The distribution of recovered kidneys by KDPI has
remained very similar.
Kidney recovery & utilization under KAS
Kidney Discard Rate by KDPI
75%
Pre-KAS (1 year)
59.9%
Post-KAS (mos. 1-6)
55.0%
50%
25%
17.2%
2.6% 2.1%
6.3%
20.3%
18.5%
18.5%
7.5%
0%
0-20
21-34
35-85
86-100
Overall
Discard rates

Discard rates initially rose during 1st six months...
Kidney recovery & utilization under KAS
Kidney Discard Rate by KDPI
75%
Pre-KAS (1 year)
Post-KAS (mos. 1-6)
Post-KAS (mos. 7-12)
59.9%
56.3%
55.0%
50%
25%
17.2%
2.6% 2.1% 2.9%
6.3%
20.3%
18.5%
18.5%
18.5% 18.0%
7.5% 6.0%
0%
0-20
21-34
35-85
86-100
Overall
Discard rates

... but subsequently stabilized. Further tracking and study
underway.
Other findings

0 ABDR mismatches declined from 8.2% to 4.7% of transplants

22% fewer transplants with 30+ year donor/recipient age difference
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Delayed graft function (DGF) rates increased from 24% to 30%.
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Six month graft survival rates* remain statistically unchanged (p=0.13)
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Pre-KAS: 95.8%
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Post-KAS: 95.2%
* Based on the first 4 months of post-KAS transplants
Summary: First Year of KAS

Overall – KAS is meeting key goals
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Increase highly sensitized recipients; tapering effect observed
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Increase in access for African Americans and high dialysis time recipients, also
with tapering observed
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Fewer longevity mismatches
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Transplant volume is up nearly 5%
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Several effects deserve further attention:
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Logistical challenges in allocation, increased CIT
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Discard rates
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Increased DGF; early graft survival rates statistically unchanged (but small N)
Questions?
Mark Aeder, MD
Committee Chair
[email protected]
Melinda Woodbury
Committee Liaison
[email protected]
20

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