1 Kidney Transplantation Committee Spring 2016. 2 Recent Public Comment Proposals OPTN Kidney...
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Transcript of 1 Kidney Transplantation Committee Spring 2016. 2 Recent Public Comment Proposals OPTN Kidney...
![Page 1: 1 Kidney Transplantation Committee Spring 2016. 2 Recent Public Comment Proposals OPTN Kidney Paired Donation (KPD) Priority Points Changes apply.](https://reader035.fdocuments.us/reader035/viewer/2022062600/5a4d1b887f8b9ab0599bdb61/html5/thumbnails/1.jpg)
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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
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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
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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
![Page 7: 1 Kidney Transplantation Committee Spring 2016. 2 Recent Public Comment Proposals OPTN Kidney Paired Donation (KPD) Priority Points Changes apply.](https://reader035.fdocuments.us/reader035/viewer/2022062600/5a4d1b887f8b9ab0599bdb61/html5/thumbnails/7.jpg)
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.
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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
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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.
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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.
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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.
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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.
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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%
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Geographic distribution of kidney transplants
The distribution of transplants by OPTN region has changed little.
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Kidney recovery under KAS
The distribution of recovered kidneys by KDPI has remained very similar.
Percentage of Recovered Deceased Kidney Donors by KDPI
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Kidney recovery & utilization under KAS
Discard rates initially rose during 1st six months...
Kidney Discard Rate by KDPI
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Kidney recovery & utilization under KAS
... but subsequently stabilized. Further tracking and study underway.
Kidney Discard Rate by KDPI
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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
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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
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Mark Aeder, MDCommittee Chair [email protected]
Melinda WoodburyCommittee Liaison [email protected]
Questions?
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