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LUNG ALLOCATION SCORE SYSTEM UPDATE

LUNG ALLOCATION SCORE SYSTEM UPDATE. Current Lung Allocation System. System was implemented on May 4, 2005 The Lung Allocation Score (LAS) is based on a combination of Expected survival in next year without a transplant and Expected survival during 1 st year with a transplant

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LUNG ALLOCATION SCORE SYSTEM UPDATE

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  1. LUNG ALLOCATION SCORE SYSTEM UPDATE

  2. Current Lung Allocation System • System was implemented on May 4, 2005 • The Lung Allocation Score (LAS) is based on a combination of • Expected survival in next year without a transplant and • Expected survival during 1st year with a transplant • Details of calculation and allocation can be found in Policy 3.7.6

  3. Components Of Current Lung Allocation System:Diagnosis Groups

  4. Number Of Lung And Heart-lung Registrations By LAS StatusActive Registrations 12+ Years N=1443 N=1667

  5. Active Lung And Heart-Lung Registrations (12+)On July 6, 2005, By Region

  6. LAS for Active Lung And Heart-Lung Registrations (12+) With Nonzero ScoresOn July 6, 2005, by Diagnosis Group

  7. Percent Of Lung and Heart-Lung Transplants Pre- And Post- Policy Implementation By Diagnosis group

  8. Lung Utilization

  9. Percent of Lungs Transplanted* May 4, 2005 – June 3, 2005 * Percent = # Lungs transplanted / donors*2

  10. Evaluation of National Kidney Allocation Policy after the Elimination of HLA-B Matching Points

  11. Background • On May 7, 2003, the kidney allocation system was modified so that: • No points for HLA-B matches • 2 points for zero HLA-DR mismatches • 1 point for one HLA-DR mismatches. • Previously: • 7 points for zero HLA-BDR mismatch • 5 points for one HLA-BDR mismatch

  12. Data/Methods • Deceased donor kidney alone transplants performed at 35 DSA’s (with standard HLA points) between 5/7/02 and 5/6/04 were included. • Pediatric recipients and recipients of expanded criteria donor (ECD) kidneys were excluded from the analysis.

  13. Data/Methods • Compare percentage of transplants by ethnicity, HLA MM level, PRA, wait time, and graft survival in two periods: • Pre-policy period: 5/7/02-5/6/03 N = 3,236 • Post-policy period: 5/7/03-5/6/04 N = 3,001

  14. Non-Zero MM Transplantsby Policy Period and Ethnicity P=0.002

  15. Non-Zero MM Transplantsby Policy Period and HLA DR MM P<0.001

  16. Non-Zero MM Transplantsby Policy Period and HLA MM P<0.001

  17. Non-Zero MM Transplantsby Policy Period and Peak PRA (%) P<0.001

  18. Non-Zero MM Transplantsby Policy Period and Wait Time P<0.001

  19. Kaplan-Meier Graft Survivalby Policy Period P=0.20

  20. Summary Compared with pre-policy period: • More minority candidates received a non-zero MM kidney transplant. • More transplants with worse HLA DR MM. • More transplants with PRA > 80%. • More transplants with longer waiting times. • Graft survival rates were similar.

  21. Evaluation of National Liver Allocation Policy after the Implementation of Share 15 Policy

  22. Background • On January 12, 2005, the liver allocation system was modified: • Local – Status 1A, Status 1B • Regional – Status 1A, Status 1B • Local – MELD/PELD > 15 • Regional – MELD/PELD > 15 • Local – MELD/PELD < 15 • Regional – MELD/PELD < 15 • National – Status 1A, Status 1B, MELD/PELD • Previously: • Local – Status 1A, Status 1B • Regional – Status 1A, Status 1B • Local – MELD/PELD • Regional – MELD/PELD • National – Status 1A, Status 1B, MELD/PELD

  23. Adult Deceased Donor Liver Transplants Pre-Policy Period: 1/12/04 – 5/11/04

  24. Adult Deceased Donor Liver Transplants Post-Policy Period: 1/12/05 – 5/11/05

  25. Adults Removed for Death/Too Sick from Liver Waiting List Pre-Policy Period: 1/12/04 – 5/11/04

  26. Adults Removed for Death/Too Sick from Liver Waiting ListPost-Policy Period: 1/12/05 – 5/11/05

  27. Death Rates per 1000 Patient DaysLiver Candidates on the Waiting List During 9/12/04 - 5/11/05By Age at Listing and Policy Period

  28. Organs Transplanted Locally vs. Non-Locally • What percentage of organs are transplanted outside the DSA? • Some are offered and refused locally, but are ultimately transplanted outside the DSA • Others are offered outside the DSA first (no local patients, Status 1 liver shares, 0MM kidneys, Statewide shares, etc.) • How well do these organs function? • UNetsm Utility for Recovering OPOs • Overall survival rates shown here (adult donors, excluding repeat txs and multiorgan txs)

  29. Kidney Transplants from Adult Donorsby Region of Recovery2003 - 2004

  30. Kidney Transplants from Adult Donorsby Region of Recovery2003 - 2004

  31. Kidney Transplants from Adult Donorsby Region of Recovery2003 - 2004

  32. Kidney Transplant* Graft Survival 2003-2004 P<0.001 * Adult donors only, excluding multiorgan and repeat transplants.

  33. Heart Transplants from Adult Donorsby Region of Recovery2003 - 2004

  34. Heart Transplants from Adult Donorsby Region of Recovery2003 - 2004

  35. Heart Transplants from Adult Donorsby Region of Recovery2003 - 2004

  36. Heart Transplant* Patient Survival 2003-2004 P=0.2 * Adult donors only, excluding multiorgan and repeat transplants.

  37. Liver Transplants from Adult Donors by Region of Recovery2003 - 2004

  38. Liver Transplants from Adult Donors by Region of Recovery2003 - 2004

  39. Liver Transplants from Adult Donorsby Region of Recovery2003 - 2004

  40. Liver Transplant* Graft Survival 2003-2004 P=0.007 * Adult donors only, excluding multiorgan and repeat transplants.

  41. Lung Transplants from Adult Donorsby Region of Recovery2003 - 2004

  42. Lung Transplants from Adult Donorsby Region of Recovery2003 - 2004

  43. Lung Transplants from Adult Donorsby Region of Recovery2003 - 2004

  44. Lung Transplant* Patient Survival 2003-2004 P=0.17 * Adult donors only, excluding multiorgan and repeat transplants.

  45. HHS PART Goals • Performance Assessment and Review Tool (PART) • 10 year and annual programmatic goals • Increase donors, transplants, life years gained for kidney tx, reduce costs per tx • Very aggressive annual goals

  46. Monthly National Donation Rates Collaborative Starts Here

  47. HRSA’S PART Goals • Increase the number of deceased donor organs transplanted • Increase the number of non-DCD donors • Increase the number of DCD donors • Increase the average number of organs transplanted per non-DCD donor • Increase the average number of organs transplanted per DCD donors

  48. HRSA’s PART GOALS • Increase the number of deceased donor organs transplanted each year until 42,800 are transplanted in 2013 Organs Txed

  49. HRSA’s PART GOALS • Increase the number of non-DCD donors each year until 9251 is achieved in 2013 # Non-DCD

  50. HRSA’s PART GOALS • Increase the number of DCD donors each year until 2018 is achieved in 2013

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