ABSTRACT
Purpose: In 2018, the OPTN board approved changes to kidney-pancreas (KP) waiting time criteria. KP candidates accrued waiting time if they were (1) on insulin and had a C-peptide <=2ng/mL or (2) on insulin and had a C-peptide >=2ng/ mL and had a BMI <=30kg/m∧2 which was the maximum allowable BMI. Since 7/11/2019 candidates must be on insulin, registered for a KP, and meeting kidney waiting time criteria. Methods: Registrations added to the waitlist and transplants between 7/11/2018- 7/10/2019 (pre-implementation) or 7/11/2019-7/10/2020 (post-implementation) were compared. Data originated from OPTN waitlist, Transplant Candidate Registration forms and Transplant Recipient Registration forms as of 10/16/2020. Results: 1,389 registrations were added to KP and 42,229 to kidney alone (KI) waitlists (pre-implementation);854 KP and 19,196 KI transplants performed. 1,401 registrations were added to KP and 19,493 KI waitlists (post-implementation);814 KP and 19,493 KI transplants performed. The proportion of type 2 diabetes (T2DM) KP candidates and recipients increased from 23.29% to 27.45% and 21.41% to 27%, respectively (Table 1). Candidate mean BMI increased from 25.7 to 26.3. KP recipients with T2DM and C-peptide >2ng/mL had higher median BMIs than those with lower C-peptide. KP post-transplant outcomes stratified by ethnicity, BMI, and diabetes status remained similar. The proportion of KI candidates and recipients remained roughly unchanged. Pediatric KI organ offers increased (527 to 592 offers per 100 active patient-years) but transplants remained unchanged. Conclusions: Changes in KP waiting time criteria did not adversely affect KI or pediatric KI candidates. Removing the BMI cutoff for obese patients with T2DM resulted in higher BMI KP transplants with equivalent post-transplant outcomes compared to lower BMI recipients. Although total KP transplants were slightly less in the post-implementation period, registrations were more and the transplant volumes were likely adversely affected by the COVID-19 pandemic.