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Kidney Transplantation Committee Update

Kidney Transplantation Committee Update. John J. Friedewald, MD Committee Chair Meetings. Ongoing Projects. Progress to develop a new national kidney allocation system Recommendations regarding variances Kidney Paired Donation. National Kidney Allocation System. Progress Update.

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Kidney Transplantation Committee Update

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  1. Kidney Transplantation Committee Update John J. Friedewald, MD Committee Chair Meetings

  2. Ongoing Projects • Progress to develop a new national kidney allocation system • Recommendations regarding variances • Kidney Paired Donation

  3. National Kidney Allocation System

  4. Progress Update • Simulation modeling completed and results reviewed by Committee • Objectives for a new system were met (limitations of current system addressed) • Committee voted to send out a policy proposal in the fall

  5. Current Working Model • Patients rank ordered by • Waiting /ESRD time • DR matching • Sliding scale CPRA • System features • A2 -> B • Broader sharing CPRA>=98% • Patients rank ordered by • Waiting/ESRD time • System features • Regional sharing • A2 -> B • Broader sharing CPRA>=98% Top 20 % KDPI to Top 20 % EPTS Allocation under “current rules” (All Candidates) Opt in system of highest 15% KDPI kidneys “Think improved ECD” 0--------------------------------20-------------------------------------------------85------------------------100 KDPI Scale

  6. Addressing System Limitations

  7. Simulation Modeling Results

  8. Summary Table

  9. Kidney Transplants by Recipient Blood Type

  10. Kidney Transplants by Recipient Age To Table

  11. Kidney Transplants by Recipient Race

  12. Kidney Transplants by 0 HLA mismatches

  13. Kidney Transplants by Organ Sharing

  14. Kidney Transplants by Recipient CPRA, with waitlist prevalence To Table

  15. N3 versus N4 N3 N4 • Local CPRA 100 • Regional CPRA 100 • National CPRA 100 • Local CPRA 99 • Regional CPRA 99 • Local CPRA 98 • first priority for all kidneys • Local CPRA 98-100 • Regional CPRA 98-100 • National CPRA 98-100 • first priority for all kidneys

  16. Kidney Transplants by Recipient cPRA, 95-100 To Table

  17. Kidney Transplants by Recipient CPRA To Table

  18. Projected median patient years of life per transplant: average, minimum, maximum of runs

  19. Projected median graft years per transplant: average, minimum, maximum of runs

  20. Projected LYFT per transplant:average, minimum, maximum of runs

  21. Variance Review Process

  22. Variances Reg 1 PADV PATF VATB OKOP TXSB TXGC The Committee received rationales from the above OPOs wishing to keep existing variances in the new allocation system

  23. Variance Recommendations • Discontinuation of all variances except for • Dialysis waiting time study • A2/A2B • Align changes to take place at the time a new kidney allocation system is implemented • Allow applications for transition • Recommendations will be circulated for public comment in the fall

  24. Timeline for KAS and Variance Proposals

  25. Kidney Paired Donation Pilot Program Update

  26. Overall Match Run Results

  27. Barriers and Potential Solutions • Centers refusing matches based on combinations of low-level antibodies • Donor Pre-Select Tool • Frequency of match runs • Now running matches twice a month • Will increase frequency as resources allow but ultimate flexibility depends on automation of the match run

  28. Barriers and Potential Solutions • Sizes of exchanges • Testing a smaller exchange size (chain cap of 4) in June match runs

  29. June 12, 2012 Match Run Results (#22)

  30. KPD Work Group Activities

  31. KPD Policy • Two proposals completing public comment: • KPD Policy to replace Operational Guidelines • Comments focused on histocompatibility section and whether the program is ready for policy language • Bridge Donor Proposal • Public comment supportive of including bridge donors • Both proposals likely to be forwarded to the Board in November 2012

  32. KPD Automated Solution Update

  33. Pre-Match Data Entry Screens • Released on December 12, 2011 • Included the ability to: • Enter KPD application from UNet℠ • Add and maintain donors and candidates • Search for donors and candidates • Verify ABO • Print records

  34. Eligibility Processing • Released on May 24, 2012: • Allows users to view whether candidates and donors are eligible for the next match run in real time • Includes warning messages for potential data entry errors

  35. Feedback from Users • “I really like the app and think it's user interface should set the standard for other programs.  It's a great first step.” • “The addition of eligibility status to the UNet KPD module is a HUGE benefit! I love it that it now tells what is still missing, so we don't have to go hunting for it. Will try to get some more pairs ready for next week's match run. "

  36. Future Functionality • Donor pre-select tool • Automation of the match run • Display of match results • Tracking of match responses

  37. Questions?

  38. Backup Slides

  39. Counts of Kidney Transplants by Recipient CPRA Back To Figure

  40. Counts of Kidney Transplants by Recipient CPRA, 95+ Back To Figure

  41. Counts of Kidney Transplants, by Recipient Age Back To Figure

  42. Sharing by cPRA 98+

  43. Sharing by 0mm

  44. Pediatric and Adult Transplants by Sharing

  45. Adult and Pediatric Transplants by Top 20/Bottom 80

  46. Top 20 recipients by HLA-mismatch

  47. Sharing by run • N2 projects a similar amount of sharing as N1 • N3 projects fewer local transplants than N1

  48. Sharing by run, continued • N4 projects fewer local transplants than N1 • N4 projects more local transplants than N3

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