1 kidney transplantation committee spring 2016. 2 recent public comment proposals optn kidney...
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3 Policy Implementation Dates OPTN KPD Deadlines and Message Boards Changes apply only to the OPTN KPD program Programs deadlines for: Match offer preliminary responses Performing crossmatches Providing and reviewing donor records Total time from offer to final acceptance/refusal = 15 business days Creates message boards for communication Board Approved: June 2015 Estimated Implementation: Within 1 st half of 2016TRANSCRIPT
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Kidney Transplantation Committee
Spring 2016
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Recent Public Comment Proposals
OPTN Kidney Paired Donation (KPD) Priority Points Changes apply only to the OPTN KPD program
Revisions to priority points (e.g. sliding scale for CPRA and donor/candidate blood type)
Remedy for candidates in a failed exchange Board Approved: Dec. 2015 Implementation: Pending Programming
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Policy Implementation Dates
OPTN KPD Deadlines and Message Boards Changes apply only to the OPTN KPD program
Programs deadlines for: Match offer preliminary responses Performing crossmatches Providing and reviewing donor records Total time from offer to final acceptance/refusal = 15 business days
Creates message boards for communication Board Approved: June 2015 Estimated Implementation: Within 1st half of 2016
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KAS UpdateSpring 2016
KAS implemented Dec 4, 2014 Key goals:
Make better use of available kidneys Increase transplant opportunities for difficult-to-match patients (increased
equity) Increase fairness by awarding waiting time points based on dialysis start date Have minimal impact on most candidates
Background
Performance tracked monthly for first six months (“out of the gate” reports)
Comprehensive, 6-month analysis provided to the kidney committee in Sep 2015
One year analysis requested by the committee (analyses underway) Pre-KAS period: Dec 4, 2013 – Dec 3, 2014 (12 months) Post-KAS period: Dec 4, 2014 – Dec 3, 2015 (12 months) Solitary, deceased donor kidney transplants
This slide set contains highlights from the full one-year report
Background
Trends in kidneys recovered and transplanted
↑ 4.6%
↑ 6.2%Kidneys recovered for
transplant
Solitary kidney transplants
Nearly 1,000 more deceased donor kidneys were recovered post-KAS, and nearly 500 more transplants occurred.
Who’s getting transplanted under KAS?Percentage of Deceased Donor Kidney Transplants by Recipient Age
More young candidates (18-49) are receiving kidney transplants. Transplants to pediatrics rebounded in 2nd six months
Who’s getting transplanted under KAS?Percentage of Deceased Donor Kidney Transplants by Recipient Race/ethnicity
More African Americans are receiving kidney transplants, although less so during the 2nd six months.
Who’s getting transplanted under KAS?Percentage of Deceased Donor Kidney Transplants by Recipient Blood Type
The distribution of transplants has changed little by recipient ABO. Slight increases for blood type B and AB patients.
Who’s getting transplanted under KAS?Percentage of Deceased Donor Kidney Transplants by Recipient CPRA
Transplants increased sharply for CPRA 99-100% patients but have tapered during the 2nd six months.
Who’s getting transplanted under KAS?Percentage of Deceased Donor Kidney Transplants by Recipient Duration on Dialysis
More transplants are going to long dialysis duration recipients. Fewer preemptive (before dialysis) transplants.
Geographic distribution of kidney transplants
More kidneys are being distributed outside recovery OPO’s DSA. CIT>24 hours: Pre-KAS 18.2%, Post-KAS 21.6%.
21.4%31.5%
Geographic distribution of kidney transplants
The distribution of transplants by OPTN region has changed little.
Kidney recovery under KAS
The distribution of recovered kidneys by KDPI has remained very similar.
Percentage of Recovered Deceased Kidney Donors by KDPI
Kidney recovery & utilization under KAS
Discard rates initially rose during 1st six months...
Kidney Discard Rate by KDPI
Kidney recovery & utilization under KAS
... but subsequently stabilized. Further tracking and study underway.
Kidney Discard Rate by KDPI
0 ABDR mismatches declined from 8.2% to 4.7% of transplants
22% fewer transplants with 30+ year donor/recipient age difference
Delayed graft function (DGF) rates increased from 24% to 30%.
Six month graft survival rates* remain statistically unchanged (p=0.13) Pre-KAS: 95.8% Post-KAS: 95.2%
Other findings
* Based on the first 4 months of post-KAS transplants
Overall – KAS is meeting key goals Increase highly sensitized recipients; tapering effect observed Increase in access for African Americans and high dialysis time recipients, also
with tapering observed Fewer longevity mismatches
Transplant volume is up nearly 5% Several effects deserve further attention:
Logistical challenges in allocation, increased CIT Discard rates Increased DGF; early graft survival rates statistically unchanged (but small N)
Summary: First Year of KAS
Mark Aeder, MDCommittee Chair [email protected]
Melinda WoodburyCommittee Liaison [email protected]
Questions?
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