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Changes in Kidney Transplantation Allocation and Criteria

The Kidney Transplantation Committee has made several important changes to the allocation process, including updates to waiting time calculations, candidate and donor classification, prioritization for sensitized candidates, blood type eligibility, pediatric kidney allocation, and kidney payback policy. This article highlights the importance of early referral and provides guidance for communicating with referring physicians. It also outlines the actions needed to implement these changes effectively. Additional resources and contact information are provided for further assistance.

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Changes in Kidney Transplantation Allocation and Criteria

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  1. Kidney Transplantation Committee Spring 2014

  2. Allocation component changes • Waiting time calculation - pre-registration dialysis time added • Candidate classification - Estimated Post Transplant Survival (EPTS) score • Kidney donor classification - replace SCD/ECD with Kidney Donor Profile Index (KDPI) • Priority for sensitized candidates - calculated panel reactive antibody (CPRA) sliding scale

  3. Allocation component changes • Blood type eligibility - A2 and A2B to B compatible • Pediatric kidney allocation – KDPI priority • Kidney payback policy – eliminated • Kidney variances – eliminated

  4. Importance of early referral Communicate with referring physicians: • Pre-emptive listing is still advantageous • Candidates can accrue time with GFR<=20ml/ml • Priority for 0-ABDR mismatch offers

  5. Change #1 – Waiting time

  6. Change #1 – Waiting time

  7. Change #2: Candidate classification

  8. Estimated Post Transplant Survival • EPTS data variables • Age • Prior transplant • Diabetes status • Time on dialysis • EPTS score range is 0 - 100%

  9. Longevity matching

  10. Action: Review waiting time

  11. Action: Input and confirm data

  12. Action: Assess for living donors • Prior living donors get 4 points

  13. Change #3 - Kidney classification

  14. Acceptance criteria • Other independent acceptance criteria may conflict with KDPI • Examples: • candidate opts out of DCD but selects KDPI max of 60% = will not see any DCD offers, even from KDPI 50% or less donors • candidate selects max donor age of 55 and KDPI of 60% = will not see offers from 56 y/o donor with KDPI 36%

  15. Action: Update acceptance criteria

  16. Action: Update consents

  17. Change #4 - Sensitized candidates

  18. Highly sensitized before 0-ABDR

  19. Action: Update unacceptable antigens (UAs)

  20. Action: Review and Approve UAs

  21. Change #5 - Blood type eligibility

  22. Action: Develop clinical criteria

  23. Implementation

  24. Save the date

  25. More information Recorded webinars, podcasts, toolkits, etc. available on: OPTN web site - http://optn.transplant.hrsa.gov (click ‘Resources’ and ‘Professional Resources’) Transplant Pro* - http://transplantpro.org (click ‘I am Looking For’ and ‘Kidney Allocation System’) *These are a service of United Network for Organ Sharing and are not produced under the OPTN contract. Subscribe to RSS feeds and a monthly newsletter at http://www.transplantpro.org

  26. Questions? • Richard Formica, MD Committee Chair • Name Region # Representative Email • Gena Boyle Committee Liaison gena.boyle@unos.org

  27. Backup Slides

  28. KDPI

  29. Point changes: Sensitization CPRA Sliding Scale (Allocation Points) (CPRA<98%) 20 17.30 18 New 16 14 12.17 12 10.82 10 Points 8 Current 6.71 6 4.05 4 2.46 1.58 2 1.09 0.81 0.48 0.34 0 0 0.21 0.08 0 0 0 10 20 30 40 50 60 70 80 90 100 CPRA CPRA

  30. Summary: Member responsibilities

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