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Early Effect of the Circular Model of Kidney Allocation in the United States.
Puttarajappa, Chethan M; Hariharan, Sundaram; Zhang, Xingyu; Tevar, Amit; Mehta, Rajil; Gunabushanam, Vikraman; Sood, Puneet; Hoffman, William; Mohan, Sumit.
  • Puttarajappa CM; Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania puttarajappacm@upmc.edu.
  • Hariharan S; Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Zhang X; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Tevar A; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Mehta R; Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Gunabushanam V; Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Sood P; Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania.
  • Hoffman W; Transplant Nephrology, UPMC Pinnacle, Harrisburg, Pennsylvania.
  • Mohan S; Department of Medicine, Division of Nephrology, Vagelos College of Physicians and Surgeons and Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York.
J Am Soc Nephrol ; 2022 Oct 27.
Article in English | MEDLINE | ID: covidwho-2234600
ABSTRACT

BACKGROUND:

In March 2021, the United States implemented a new kidney allocation system (KAS250) for deceased donor kidney transplantation (DDKT), which eliminated the donation service area-based allocation and replaced it with a system on the basis of distance from donor hospital to transplant center within/outside a radius of 250 nautical miles. The effect of this policy on kidney discards and logistics is unknown.

METHODS:

We examined discards, donor-recipient characteristics, cold ischemia time (CIT), and delayed graft function (DGF) during the first 9 months of KAS250 compared with a pre-KAS250 cohort from the preceding 2 years. Changes in discards and CIT after the onset of COVID-19 and the implementation of KAS250 were evaluated using an interrupted time-series model. Changes in allocation practices (biopsy, machine perfusion, and virtual cross-match) were also evaluated.

RESULTS:

Post-KAS250 saw a two-fold increase in kidneys imported from nonlocal organ procurement organizations (OPO) and a higher proportion of recipients with calculated panel reactive antibody (cPRA) 81%-98% (12% versus 8%; P<0.001) and those with >5 years of pretransplant dialysis (35% versus 33%; P<0.001). CIT increased (mean 2 hours), including among local OPO kidneys. DGF was similar on adjusted analysis. Discards after KAS250 did not immediately change, but we observed a statistically significant increase over time that was independent of donor quality. Machine perfusion use decreased, whereas reliance on virtual cross-match increased, which was associated with shorter CIT.

CONCLUSIONS:

Early trends after KAS250 show an increase in transplant access to patients with cPRA>80% and those with longer dialysis duration, but this was accompanied by an increase in CIT and a suggestion of worsening kidney discards.
Keywords

Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal subject: Nephrology Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Language: English Journal subject: Nephrology Year: 2022 Document Type: Article