Changes in offer and acceptance patterns for pediatric kidney transplant candidates under the new Kidney Allocation System

Kyle R. Jackson, Mary G. Bowring, Amber Kernodle, Brian Boyarsky, Niraj Desai, Olga Charnaya, Jacqueline Garonzik-Wang, Allan B. Massie, Dorry L. Segev

Research output: Contribution to journalArticlepeer-review

Abstract

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.

Original languageEnglish (US)
Pages (from-to)2234-2242
Number of pages9
JournalAmerican Journal of Transplantation
Volume20
Issue number8
DOIs
StatePublished - Aug 1 2020

Keywords

  • clinical research/practice
  • health services and outcomes research
  • kidney transplantation/nephrology
  • organ allocation
  • organ procurement and allocation
  • pediatrics
  • registry/registry analysis

ASJC Scopus subject areas

  • Immunology and Allergy
  • Transplantation
  • Pharmacology (medical)

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