Living Donors Still “at the Top of the List” for Kidney Transplant

Early experience under the revised kidney allocation system (KAS) shows continued quick access to high-quality deceased-donor organs for prior living donors (PLDs), reports a study in the American Journal of Transplantation.

Using Organ Procurement and Transplantation Network data, the researchers compared access to deceased donor kidney transplants for two groups of PLDs. The study compared prevalent and incident cohorts of 50 patients for the year before KAS implementation in December 2014, and 39 patients for the year after implementation. Transplant rates per patient-year and waiting times were assessed, along with the Kidney Donor Profile Index (KDPI) of the transplanted kidneys.

There was no significant difference in transplant rates from before to after KAS implementation: 2.27 versus 2.29 for prevalent candidates and 4.76 versus 4.36 for incident candidates. Median waiting time to transplantation for prevalent PLDs was 83.2 days in the pre-KAS cohort and 102.6 days in the post-KAS cohort. This increase was neither clinically nor statistically significant.

Median KDPI for prevalent PLDs was 23% in the pre-KAS cohort versus 31% in the post-KAS cohort. Ninety-five percent of kidneys transplanted in PLDs in the post-KAS cohort were in the range of KDPIs transplanted in children during the same period. Despite a sharp decrease in waiting time for high-priority candidates with calculated panel reactive antibodies of 98% to 100%, PLDs still had much shorter waiting times.

Although living kidney donation is generally a safe procedure, the number of PLDs who later require kidney transplantation is “not negligible.” The new KAS was designed to maintain high-priority for kidney transplantation in special populations, including children and PLDs.

This early evaluation suggests that PLDs are still “at the top of the list” for access to kidney transplantation under the revised KAS, with very short waiting times for high-quality organs. The authors call for continued assessment to ensure that PLDs’ access to transplantation does not decrease unexpectedly [Wainwright JL, et al. The impact of the new kidney allocation system on prior living kidney donors’ access to deceased donor kidney transplants: an early look. Am J Transpl 2017; 17:1103–1111].