kidney transplantation committee spring 2014. 1.waiting time calculation - pre-registration dialysis...
TRANSCRIPT
Kidney Transplantation Committee
Spring 2014
1. Waiting time calculation - pre-registration dialysis time added
2. Candidate classification - Estimated Post Transplant Survival (EPTS) score
3. Kidney donor classification - replace SCD/ECD with Kidney Donor Profile Index (KDPI)
4. Priority for sensitized candidates - calculated panel reactive antibody (CPRA) sliding scale
Allocation component changes
5. Blood type eligibility - A2 and A2B to B compatible
6. Pediatric kidney allocation – KDPI priority
7. Kidney payback policy – eliminated
8. Kidney variances – eliminated
Allocation component changes
Communicate with referring physicians:
oPre-emptive listing is still advantageous
oCandidates can accrue time with GFR<=20ml/ml
oPriority for 0-ABDR mismatch offers
Importance of early referral
Current New
Adult Accrue time when listed, and:
on dialysis
or
when GFR or CRCL is =/< 20 ml/min
Accrue time when listed, and: on dialysis (with credit for time spent on dialysis prior to listing)or
when GFR is =/< 20 ml/min
Change #1 – Waiting time
Current New
Pediatric Accrue time immediately when listed
Accrue time immediately when listed and Credit for time spent on dialysis before listing
Change #1 – Waiting time
Change #2: Candidate classification
Current New
No priority based on estimated post-transplant survival
The 20% of adult candidates who have the longest EPTS receive priority for kidneys from donors with KDPI scores in the top 20%.
EPTS data variables o Ageo Prior transplanto Diabetes statuso Time on dialysis
EPTS score range is 0 - 100%
Estimated Post Transplant Survival
Sequence AKDPI <=20%
Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
Longevity matching
Action: Review waiting time
Action: Input and confirm data
Prior living donors get 4 points
Action: Assess for living donors
Current New
Classified as SCD or ECD based on:o donor ageo history of hypertensiono creatinine o cerebrovascular accident as
cause of death
Classified by KDPI based on:odonor ageoheight oweight oethnicityohistory of hypertension ohistory of diabetes ocause of death oserum creatinineohepatitis C virus statusodonation after circulatory death
Change #3 - Kidney classification
Other independent acceptance criteria may conflict with KDPI
Examples:
o candidate opts out of DCD but selects KDPI max of 60% = will not see any DCD offers, even from KDPI 50% or less donors
o candidate selects max donor age of 55 and KDPI of 60% = will not see offers from 56 y/o donor with KDPI 36%
Acceptance criteria
Action: Update acceptance criteria
Action: Update consents
Current Priority New Priority
CPRA score at or above 80% receives 4 points
Moderately sensitized (CPRA 0-79%) receive zero points
CPRA scores of 20% or above receive points based on a sliding scale
Change #4 - Sensitized candidates
Sequence AKDPI <=20%
Sequence BKDPI >20% but
<35%
Sequence CKDPI >=35% but
<=85%
Sequence DKDPI>85%
Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)
Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults
Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational
Highly Sensitized0-ABDRmmLocal + Regional National
Highly sensitized before 0-ABDR
Action: Update unacceptable antigens (UAs)
Action: Review and Approve UAs
Current New
Kidneys allocated to candidates who are blood type identical to the donor when the donor has blood type O or B. Blood type B candidates are ineligible for A2/A2B offers.
Blood type B candidates that meet defined clinical criteria are eligible for kidneys from donors with blood type A2 or A2B.
Change #5 - Blood type eligibility
Action: Develop clinical criteria
Implementation
Phase I Phase II
• Data updates begin• New reports released• Calculators made available
• New allocation rules applied • Variances turned off• Payback system turned off
Summer 2014 December 2014
Save the date
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OPTN web site - http://optn.transplant.hrsa.gov (click ‘Resources’ and ‘Professional Resources’)
Transplant Pro* - http://transplantpro.org (click ‘I am Looking For’ and ‘Kidney Allocation System’)*These are a service of United Network for Organ Sharing and are not produced under the OPTN contract.
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More information
Richard Formica, MD Committee Chair
Name Region # Representative Email
Gena Boyle Committee Liaison [email protected]
Questions?
Backup Slides
KDPI
Point changes: Sensitization
CPRA
0 0 0 0.08 0.21 0.34 0.48 0.81 1.091.58 2.46
4.05
6.71
10.82
12.17
17.30
02468
101214161820
0 10 20 30 40 50 60 70 80 90 100
Po
ints
CPRA Sliding Scale (Allocation Points)(CPRA<98%)
Current
New
CPRA
Summary: Member responsibilities
Communicate importance of early referral
Establish protocols for A2 and A2B donors to B candidates
Report/update data to calculate EPTS and waiting time
Review candidates to identify prior living organ donors
Establish KDPI acceptance criteria and update consents for KDPI>85%
Review waiting list for unacceptable antigens
Review “other” donor screening criteria
Educate candidates and potential candidates on changes