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Kidney Week

Abstract: PO2060

Organ Procurement and Transplantation Network Effort to Increase Kidney Transplantation Through Kidney Accelerated Placement

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Noreen, Samantha, United Network for Organ Sharing, Richmond, Virginia, United States
  • Klassen, David, United Network for Organ Sharing, Richmond, Virginia, United States
  • Cooper, Matthew, MedStar Health, Columbia, Maryland, United States
  • Placona, Andrew, United Network for Organ Sharing, Richmond, Virginia, United States
Background

In 2017 just over a quarter of kidneys deemed hard to place were transplanted while the rest were discarded. The Kidney Accelerated Placement (KAP) project aimed to increase the acceptance of these deceased donor kidneys, declined by a large proportion of programs, through the creation of a novel allocation system. Offering hard-to-place kidneys to transplant centers with a history of transplanting similar organs, utilization would increase by reducing time to find an acceptor and cold ischemia time (CIT) within the deceased organ allocation process. We hypothesized CIT mediated the effect of KAP on transplant center organ-level offer acceptance.

Methods

We used a pre/post design mediation analysis with OPTN database offers from kidney matches meeting criteria for KAP 7/18/18-7/15/19 (pre-KAP) and 7/18/19-7/15/20 (KAP). We employed logistic regression models of KAP and CIT on organ acceptance and a linear regression model of KAP on CIT, adjusting for additional risk factors (Fig 1).

Results

Transplant center organ-level offer acceptance rates were 0.37%(pre-KAP) and 0.23%(KAP). The total effect indicates that KAP increased odds of acceptance by 0.07. Decreases in CIT increased odds of acceptance by 0.02 (indirect effect) and the remaining portion of the total effect is attributable to other possible mechanisms (direct effect).

Conclusion

While KAP affected offer acceptance, the magnitude of the effect was small. Because the baseline level of offer acceptance was also small, our analysis indicates that KAP works conceptually to increase the use of these kidneys. At the same time, there is evidence that alternative approaches to KAP are needed to potentially decrease organ discard. Future iterations plan to consider complex risk adjustment including behaviors and the differential impact for donor types.