TY - JOUR
T1 - Changes in offer and acceptance patterns for pediatric kidney transplant candidates under the new Kidney Allocation System
AU - Jackson, Kyle R.
AU - Bowring, Mary G.
AU - Kernodle, Amber
AU - Boyarsky, Brian
AU - Desai, Niraj
AU - Charnaya, Olga
AU - Garonzik-Wang, Jacqueline
AU - Massie, Allan B.
AU - Segev, Dorry L.
N1 - Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Stakeholders have expressed concerns regarding decreased deceased donor kidney transplant (DDKT) rates for pediatric candidates under the Kidney Allocation System (KAS). To better understand what might be driving this, we studied Scientific Registry of Transplant Recipients kidney offer data for 3642 pediatric (age <18 years) kidney-only transplant candidates between December 31, 2012 to December 3, 2014 (pre-KAS) and December 4, 2014 to January 6, 2017 (post-KAS). We used negative binomial regression and multilevel logistic regression to compare offer and acceptance rates pre- and post-KAS. We stratified by donor age (<18, 18-34, and 35+ years) and KDPI (<35% and ≥35%) to reflect differing allocation prioritization pre-KAS and post-KAS. As might be expected from prioritization changes, post-KAS candidates were less likely to receive offers for donors 18-34 years old with KDPI ≥ 35% (adjusted incidence rate ratio [aIRR]: 0.180.210.25, P <.001), and more likely to receive offers for donors 18-34 years old and KDPI < 35% (aIRR: 1.121.201.29, P <.001). However, offer acceptance practices also changed post-KAS: kidneys from donors 18-34 years old and KDPI < 35% were 23% less likely to be accepted post-KAS (adjusted odds ratio: 0.610.770.98, P =.03). Using kidneys from donors 18-34 years old with KDPI < 35% post-KAS to the same extent they were used pre-KAS might be an effective strategy to mitigate any decrease in DDKT rates for pediatric candidates.
AB - Stakeholders have expressed concerns regarding decreased deceased donor kidney transplant (DDKT) rates for pediatric candidates under the Kidney Allocation System (KAS). To better understand what might be driving this, we studied Scientific Registry of Transplant Recipients kidney offer data for 3642 pediatric (age <18 years) kidney-only transplant candidates between December 31, 2012 to December 3, 2014 (pre-KAS) and December 4, 2014 to January 6, 2017 (post-KAS). We used negative binomial regression and multilevel logistic regression to compare offer and acceptance rates pre- and post-KAS. We stratified by donor age (<18, 18-34, and 35+ years) and KDPI (<35% and ≥35%) to reflect differing allocation prioritization pre-KAS and post-KAS. As might be expected from prioritization changes, post-KAS candidates were less likely to receive offers for donors 18-34 years old with KDPI ≥ 35% (adjusted incidence rate ratio [aIRR]: 0.180.210.25, P <.001), and more likely to receive offers for donors 18-34 years old and KDPI < 35% (aIRR: 1.121.201.29, P <.001). However, offer acceptance practices also changed post-KAS: kidneys from donors 18-34 years old and KDPI < 35% were 23% less likely to be accepted post-KAS (adjusted odds ratio: 0.610.770.98, P =.03). Using kidneys from donors 18-34 years old with KDPI < 35% post-KAS to the same extent they were used pre-KAS might be an effective strategy to mitigate any decrease in DDKT rates for pediatric candidates.
KW - clinical research/practice
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - organ allocation
KW - organ procurement and allocation
KW - pediatrics
KW - registry/registry analysis
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U2 - 10.1111/ajt.15799
DO - 10.1111/ajt.15799
M3 - Article
C2 - 32012451
AN - SCOPUS:85088776636
SN - 1600-6135
VL - 20
SP - 2234
EP - 2242
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -