Is the Updated Kidney Allocation System Working?

AbstractPurpose of ReviewIn December 2014, the current kidney allocation system (KAS) was implemented after over 10  years of development by the OPTN Kidney Committee. The Kidney Committee noted several limitations with the prior kidney allocation schema and sought to improve many of these limitations. This review will discuss those goals and the available results at a 2-year review.Recent FindingsTwo-year results of the new kidney allocation system: This system increased the allocation of allografts with longer expected function as estimated by the Kidney Donor Profile Index (KDPI) to those patients with longer expected post-transplant survival as estimated by the recipients ’ EPTS score or the estimated post-transplant survival score. A large increase in transplantation to those who are highly sensitized, calculated panel reactive antibody (CPRA) 98% or greater has also occurred as planned. Redefining the start of waiting time to the start of chronic dialysis time re sulted in a great increase in minority transplantation and to those with a long time of dialysis. There was a small increase in transplantation to blood type B candidates.Challenges: Organ discards have still increased compared to before the implementation of the new KAS, likely due to factors not addressed by the KAS such as the regulatory concerns (performance metric flagging) and financial costs of transplanting higher KDPI organs and higher EPTS candidates. There was a large “bolus” effect in the fir...
Source: Current Transplantation Reports - Category: Transplant Surgery Source Type: research