Early changes in kidney distribution under the new allocation system

Allan B. Massie, Xun Luo, Bonnie E. Lonze, Niraj M. Desai, Adam W. Bingaman, Matthew Cooper, Dorry L. Segev

Research output: Contribution to journalArticlepeer-review


The Kidney Allocation System (KAS), a major change to deceased donor kidney allocation, was implemented in December 2014. Goals of KAS included directing the highest-quality organs to younger/healthier recipients and increasing access to deceased donor kidney transplantation (DDKT) for highly sensitized patients and racial/ethnic minorities. Using national registry data, we compared kidney distribution, DDKT rates for waitlist registrants, and recipient characteristics between January 1, 2013, and December 3, 2014 (pre-KAS) with those between December 4, 2014, and August 31, 2015 (post-KAS). Regional imports increased from 8.8% pre-KAS to 12.5% post-KAS; national imports increased from 12.7% pre-KAS to 19.1% post-KAS (P,0.001). The proportion of recipients .30 years older than their donor decreased from 19.4% to 15.0% (P,0.001). The proportion of recipients with calculated panelreactive antibody =100 increased from 1.0% to 10.3% (P,0.001). Overall DDKT rate did not change as modeled using exponential regression adjusting for candidate characteristics (P=0.07). However, DDKT rate (incidence rate ratio, 95% confidence interval) increased for black (1.19; 1.13 to 1.25) and Hispanic (1.13; 1.05 to 1.20) candidates and for candidates aged 18-40 (1.47; 1.38 to 1.57), but declined for candidates aged .50 (0.93; 0.87 to 0.98 for aged 51-60 and 0.90; 0.85 to 0.96 for aged .70). Delayed graft function in transplant recipients increased from 24.8% pre-KAS to 29.9% post-KAS (P,0.001). Thus, in the first 9 months under KAS, access to DDKT improved for minorities, younger candidates, and highly sensitized patients, but declined for older candidates. Delayed graft function increased substantially, possibly suggesting poorer long-term outcomes.

Original languageEnglish (US)
Pages (from-to)2495-2501
Number of pages7
JournalJournal of the American Society of Nephrology
Issue number8
StatePublished - 2016

ASJC Scopus subject areas

  • Nephrology


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