New priorities: Analysis of the New Kidney Allocation System on UCLA patients transplanted from the deceased donor waitlist.

Aim UNOS implemented a new kidney allocation system (New KAS) on December 4, 2014 with the goal of increasing patient and allograft post-transplant survival. We aimed to determine the effects of the New KAS on UCLA patients transplanted from the deceased donor waitlist in comparison to the previous allocation system (Previous KAS). Methods We evaluated kidney transplants from the deceased donor waitlist during the first year of the New KAS (12/4/2014–12/4/2015) and compared to the same time period during the Previous KAS (12/4/2013–12/3/2014). Demographic and clinical information were collected by reviewing the patient’s UNOS removal data and medical record. Information describing deceased donors was gathered from UNOS DonorNet. Results The total number of deceased donor kidney transplants was increased in the New KAS as compared to the Previous KAS (176 vs 147). Transplant of regraft patients and of highly sensitized patients with cPRA ≥98% 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, 59.6% and 51.6% of imported organs were allocated to very highly sensitized (≥99% cPRA) or re-graft patients, respectively, as compared to 8.7% and 21.7% during the Previous KAS. 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). We have not observed a paucity in transplant of pediatric patients (0–17 years, New KAS vs Previous KAS, 6.2% vs 4.1%, respectively). The percentage of patients transplanted with preformed donor specific antibody (DSA) was similar in the New KAS in comparison to the Previous KAS (19.7% vs 15.6%). Conclusion The data show that the New KAS is working as designed to better age match recipients and donors and to increase transplantation of very highly sensitized patients through broader sharing.