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Kidney Week

Abstract: PO2514

Median Waiting Time of Kidney Transplant Candidates with Initial Estimated Post Transplant Survival Score >90% According to Organ Procurement Organization Waiting Time

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Homkrailas, Piyavadee, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Lum, Erik Lawrence, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Datta, Nakul N., University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
  • Bunnapradist, Suphamai, University of California Los Angeles David Geffen School of Medicine, Los Angeles, California, United States
Background

The kidney allocation system (KAS) and the Estimated Post Transplant Survival (EPTS) score were introduced in the United States in December 2014. The transplant rate among very high EPTS candidates (>90%) may be impacted by lack of KAS priority, geographic factors based on the location of the listed Organ Procurement Organization (OPO), and/or differences in waitlist mortality/delisting. Here we study the impact of new KAS among the candidates with EPTS>90%.

Methods

The Organ Procurement Transplantation Network/United Network for Organ Sharing (OPTN/UNOS) data of newly listed first time transplant candidates from 2015-2018 were included. Individuals listed for multiple organs, at multiple centers, and age < 18 years were excluded. The outcomes included median waiting time to transplant, transplant rate, death rate and delisting rate among candidates with EPTS>90% compared to those with EPTS≤90%. Median waiting time was calculated by Kaplan-Meier model with censoring for still waiting candidates.

Results

A total of 114,870 candidates were included. Candidates with EPTS>90% (9.74%) had a lower rate of overall transplant compared with EPTS≤90% (30.3% vs. 45.9%, p<0.001), higher rate of deceased donor transplant (87.2% vs. 60.9%, p<0.001), lower rate of living donor transplant (12.8% vs. 39.1%, p<0.001), higher death rate (8.8% vs. 5.73%, p<0.001) and higher delisting rate (22.9% vs. 13.3%, p<0.001). Overall median waiting time to transplant was 444 days (range 188-1,042 days among OPOs) compared to 1,025 days (range 160-1,633 days among OPOs) in those with EPTS>90% (p<0.001).

Conclusion

Candidates with EPTS>90% had a longer median waiting time compared to total waitlisted in all but one OPO. Median waiting times were heavily influenced by the lower overall rate of kidney transplantation and living donor transplantation in this group.