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New Priorities: Analysis of the New Kidney Allocation System on UCLA Patients Transplanted from the Deceased Donor Waitlist
Abstract UNOS implemented a new kidney allocation system (New KAS) on December 4, 2014 with a primary goal of increasing equity to organ transplant for patients that were immunologically or socially disadvantaged by the previous allocation system (Previous KAS) that prioritized long wait times. We e...
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| Published in: | Human immunology 2017-01, Vol.78 (1), p.41-48 |
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| creator | Hickey, Michelle J Zheng, Ying Valenzuela, Nicole Zhang, Qiuheng Krystal, Carolyn Lum, Erik Tsai, Eileen W Lipshutz, Gerald S Albin Gritsch, H Danovitch, Gabriel Veale, Jeffrey Gjertson, David Cecka, Michael Reed, Elaine F |
| description | Abstract UNOS implemented a new kidney allocation system (New KAS) on December 4, 2014 with a primary goal of increasing equity to organ transplant for patients that were immunologically or socially disadvantaged by the previous allocation system (Previous KAS) that prioritized long wait times. We examined the effects of the New KAS on patients transplanted from the UCLA deceased donor waitlist during the first year and compared to the last year of the Previous KAS. The total number of deceased donor kidney transplants was increased in the New KAS as compared to the Previous KAS (178 vs 148). Transplant of regraft patients and of highly sensitized patients with cPRA ⩾99% was significantly increased in the New KAS (New KAS vs Previous KAS, 29.8% vs 11.5%, p ⩽0.0001, and 26.4% vs 2.7%, p ⩽0.0001, respectively). In the New KAS, the percentage of patient’s receiving allografts imported from outside our local area was also significantly increased (34.8% vs 15.5%, p |
| doi_str_mv | 10.1016/j.humimm.2016.10.020 |
| format | article |
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We examined the effects of the New KAS on patients transplanted from the UCLA deceased donor waitlist during the first year and compared to the last year of the Previous KAS. The total number of deceased donor kidney transplants was increased in the New KAS as compared to the Previous KAS (178 vs 148). Transplant of regraft patients and of highly sensitized patients with cPRA ⩾99% was significantly increased in the New KAS (New KAS vs Previous KAS, 29.8% vs 11.5%, p ⩽0.0001, and 26.4% vs 2.7%, p ⩽0.0001, respectively). In the New KAS, the percentage of patient’s receiving allografts imported from outside our local area was also significantly increased (34.8% vs 15.5%, p <0.0001). In the New KAS, 59.7% and 48.3% of imported organs were allocated to very highly sensitized (⩾99% cPRA) or re-graft patients, respectively, as compared to 8.7% and 8.7% during the Previous KAS ( p <0.001). Recipients and donors with age differences exceeding 15 years were decreased in the New KAS as compared to the Previous KAS (36.5 vs 48.7%, p ⩽0.032). There was a 40.1% reduction in transplant to patients in the 65+ age group in the New KAS ( p ⩽0.025). The percentage of patients transplanted with preformed donor specific antibody (DSA) was similar in the New as compared to the Previous KAS (19.7% vs 15.5%) and, patients were transplanted with a range of 1-3 preformed DSA of weak to moderate strength. Cold ischemic time was significantly increased over all organs, and in patients transplanted with preformed DSA during the New as compared to the Previous KAS (17.5 vs 19.1 hours and 17.2 vs 22.2, p <0.04 and p <0.03, respectively). Episodes of delayed graft function and the number of biopsies for cause were similar between the New and the Previous KAS. However, there were more events of biopsy proven antibody mediated rejection in patients transplanted since the start of the New KAS. The data show that the New KAS is working at the center level as designed to better age match recipients and donors and to increase transplantation of very highly sensitized patients through broader sharing.</description><identifier>ISSN: 0198-8859</identifier><identifier>EISSN: 1879-1166</identifier><identifier>DOI: 10.1016/j.humimm.2016.10.020</identifier><identifier>PMID: 27818166</identifier><language>eng</language><publisher>United States: Elsevier Inc</publisher><subject>Academic Medical Centers ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Allergy and Immunology ; Cadaver ; Child ; Child, Preschool ; Clinical Protocols ; Donor specific antibody ; Female ; Government Regulation ; Histocompatibility Testing ; HLA Antigens - immunology ; Humans ; Isoantibodies - metabolism ; Kidney Allocation System ; Kidney Transplantation ; Male ; Middle Aged ; Renal ; Tissue and Organ Procurement ; Tissue Donors ; Transplant ; Transplant Recipients ; United States ; UNOS ; Waiting Lists ; Young Adult</subject><ispartof>Human immunology, 2017-01, Vol.78 (1), p.41-48</ispartof><rights>The Author(s)</rights><rights>2016 The Author(s)</rights><rights>Copyright © 2016 The Author(s). Published by Elsevier Inc. All rights reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c463t-d811da23bb10f1b6c53c84d94cda5542a1504ca9708d2714cf1bbd6f71ec69ef3</citedby><cites>FETCH-LOGICAL-c463t-d811da23bb10f1b6c53c84d94cda5542a1504ca9708d2714cf1bbd6f71ec69ef3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>315,786,790,27957,27958</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/27818166$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Hickey, Michelle J</creatorcontrib><creatorcontrib>Zheng, Ying</creatorcontrib><creatorcontrib>Valenzuela, Nicole</creatorcontrib><creatorcontrib>Zhang, Qiuheng</creatorcontrib><creatorcontrib>Krystal, Carolyn</creatorcontrib><creatorcontrib>Lum, Erik</creatorcontrib><creatorcontrib>Tsai, Eileen W</creatorcontrib><creatorcontrib>Lipshutz, Gerald S</creatorcontrib><creatorcontrib>Albin Gritsch, H</creatorcontrib><creatorcontrib>Danovitch, Gabriel</creatorcontrib><creatorcontrib>Veale, Jeffrey</creatorcontrib><creatorcontrib>Gjertson, David</creatorcontrib><creatorcontrib>Cecka, Michael</creatorcontrib><creatorcontrib>Reed, Elaine F</creatorcontrib><title>New Priorities: Analysis of the New Kidney Allocation System on UCLA Patients Transplanted from the Deceased Donor Waitlist</title><title>Human immunology</title><addtitle>Hum Immunol</addtitle><description>Abstract UNOS implemented a new kidney allocation system (New KAS) on December 4, 2014 with a primary goal of increasing equity to organ transplant for patients that were immunologically or socially disadvantaged by the previous allocation system (Previous KAS) that prioritized long wait times. We examined the effects of the New KAS on patients transplanted from the UCLA deceased donor waitlist during the first year and compared to the last year of the Previous KAS. The total number of deceased donor kidney transplants was increased in the New KAS as compared to the Previous KAS (178 vs 148). Transplant of regraft patients and of highly sensitized patients with cPRA ⩾99% was significantly increased in the New KAS (New KAS vs Previous KAS, 29.8% vs 11.5%, p ⩽0.0001, and 26.4% vs 2.7%, p ⩽0.0001, respectively). In the New KAS, the percentage of patient’s receiving allografts imported from outside our local area was also significantly increased (34.8% vs 15.5%, p <0.0001). In the New KAS, 59.7% and 48.3% of imported organs were allocated to very highly sensitized (⩾99% cPRA) or re-graft patients, respectively, as compared to 8.7% and 8.7% during the Previous KAS ( p <0.001). Recipients and donors with age differences exceeding 15 years were decreased in the New KAS as compared to the Previous KAS (36.5 vs 48.7%, p ⩽0.032). There was a 40.1% reduction in transplant to patients in the 65+ age group in the New KAS ( p ⩽0.025). The percentage of patients transplanted with preformed donor specific antibody (DSA) was similar in the New as compared to the Previous KAS (19.7% vs 15.5%) and, patients were transplanted with a range of 1-3 preformed DSA of weak to moderate strength. Cold ischemic time was significantly increased over all organs, and in patients transplanted with preformed DSA during the New as compared to the Previous KAS (17.5 vs 19.1 hours and 17.2 vs 22.2, p <0.04 and p <0.03, respectively). Episodes of delayed graft function and the number of biopsies for cause were similar between the New and the Previous KAS. However, there were more events of biopsy proven antibody mediated rejection in patients transplanted since the start of the New KAS. The data show that the New KAS is working at the center level as designed to better age match recipients and donors and to increase transplantation of very highly sensitized patients through broader sharing.</description><subject>Academic Medical Centers</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Allergy and Immunology</subject><subject>Cadaver</subject><subject>Child</subject><subject>Child, Preschool</subject><subject>Clinical Protocols</subject><subject>Donor specific antibody</subject><subject>Female</subject><subject>Government Regulation</subject><subject>Histocompatibility Testing</subject><subject>HLA Antigens - immunology</subject><subject>Humans</subject><subject>Isoantibodies - metabolism</subject><subject>Kidney Allocation System</subject><subject>Kidney Transplantation</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Renal</subject><subject>Tissue and Organ Procurement</subject><subject>Tissue Donors</subject><subject>Transplant</subject><subject>Transplant Recipients</subject><subject>United States</subject><subject>UNOS</subject><subject>Waiting Lists</subject><subject>Young Adult</subject><issn>0198-8859</issn><issn>1879-1166</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2017</creationdate><recordtype>article</recordtype><recordid>eNqFUU1v1DAQtRCILoV_gJCPXLJ4EidxOCCttnxUXZVKbQU3y7EnqpckXmwHFPHncdjCgUtPtp_fvJl5j5CXwNbAoHqzX99Ngx2GdZ5eCVqznD0iKxB1kwFU1WOyYtCITIiyOSHPQtgzxmpW86fkJK8FiMRZkV-X-JNeeeu8jRbDW7oZVT8HG6jraLxDuvxfWDPiTDd977SK1o30eg4RB5put9vdhl4lFMcY6I1XYzj0aoxoaOfd8EfjDDWqkJAzNzpPvygbexvic_KkU33AF_fnKbn98P5m-ynbff54vt3sMs2rImZGABiVF20LrIO20mWhBTcN10aVJc8VlIxr1dRMmLwGrhOpNVVXA-qqwa44Ja-Pugfvvk8Yohxs0NinMdFNQYIoalYw4JCo_EjV3oXgsZMHbwflZwlMLrbLvTzaLhfbFzTZnspe3XeY2gHNv6K_PifCuyMB054_LHoZdHJMo7EedZTG2Yc6_C-geztarfpvOGPYu8mn4NIuMuSSyesl-iV5qArGRfO1-A0e5qui</recordid><startdate>20170101</startdate><enddate>20170101</enddate><creator>Hickey, Michelle J</creator><creator>Zheng, Ying</creator><creator>Valenzuela, Nicole</creator><creator>Zhang, Qiuheng</creator><creator>Krystal, Carolyn</creator><creator>Lum, Erik</creator><creator>Tsai, Eileen W</creator><creator>Lipshutz, Gerald S</creator><creator>Albin Gritsch, H</creator><creator>Danovitch, Gabriel</creator><creator>Veale, Jeffrey</creator><creator>Gjertson, David</creator><creator>Cecka, Michael</creator><creator>Reed, Elaine F</creator><general>Elsevier Inc</general><scope>6I.</scope><scope>AAFTH</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20170101</creationdate><title>New Priorities: Analysis of the New Kidney Allocation System on UCLA Patients Transplanted from the Deceased Donor Waitlist</title><author>Hickey, Michelle J ; 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We examined the effects of the New KAS on patients transplanted from the UCLA deceased donor waitlist during the first year and compared to the last year of the Previous KAS. The total number of deceased donor kidney transplants was increased in the New KAS as compared to the Previous KAS (178 vs 148). Transplant of regraft patients and of highly sensitized patients with cPRA ⩾99% was significantly increased in the New KAS (New KAS vs Previous KAS, 29.8% vs 11.5%, p ⩽0.0001, and 26.4% vs 2.7%, p ⩽0.0001, respectively). In the New KAS, the percentage of patient’s receiving allografts imported from outside our local area was also significantly increased (34.8% vs 15.5%, p <0.0001). In the New KAS, 59.7% and 48.3% of imported organs were allocated to very highly sensitized (⩾99% cPRA) or re-graft patients, respectively, as compared to 8.7% and 8.7% during the Previous KAS ( p <0.001). Recipients and donors with age differences exceeding 15 years were decreased in the New KAS as compared to the Previous KAS (36.5 vs 48.7%, p ⩽0.032). There was a 40.1% reduction in transplant to patients in the 65+ age group in the New KAS ( p ⩽0.025). The percentage of patients transplanted with preformed donor specific antibody (DSA) was similar in the New as compared to the Previous KAS (19.7% vs 15.5%) and, patients were transplanted with a range of 1-3 preformed DSA of weak to moderate strength. Cold ischemic time was significantly increased over all organs, and in patients transplanted with preformed DSA during the New as compared to the Previous KAS (17.5 vs 19.1 hours and 17.2 vs 22.2, p <0.04 and p <0.03, respectively). Episodes of delayed graft function and the number of biopsies for cause were similar between the New and the Previous KAS. However, there were more events of biopsy proven antibody mediated rejection in patients transplanted since the start of the New KAS. The data show that the New KAS is working at the center level as designed to better age match recipients and donors and to increase transplantation of very highly sensitized patients through broader sharing.</abstract><cop>United States</cop><pub>Elsevier Inc</pub><pmid>27818166</pmid><doi>10.1016/j.humimm.2016.10.020</doi><tpages>8</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Academic Medical Centers Adolescent Adult Aged Aged, 80 and over Allergy and Immunology Cadaver Child Child, Preschool Clinical Protocols Donor specific antibody Female Government Regulation Histocompatibility Testing HLA Antigens - immunology Humans Isoantibodies - metabolism Kidney Allocation System Kidney Transplantation Male Middle Aged Renal Tissue and Organ Procurement Tissue Donors Transplant Transplant Recipients United States UNOS Waiting Lists Young Adult |
| title | New Priorities: Analysis of the New Kidney Allocation System on UCLA Patients Transplanted from the Deceased Donor Waitlist |
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