The effect of change in the kidney allocation policy on outcomes of a sole transplant center in a single Donor Service Area (DSA)
Abigail Cheng2, Chelsey Wongjirad1,2, Mary Froehlich2, SUNIL K PATEL1.
1UMC Center for Transplantation, University Medical Center of Southern Nevada, Las Vegas, NV, United States; 2Surgery, UNLV School of Medicine, Las Vegas, NV, United States
Purpose: The change in the organ allocation policy , eliminating DSAs for allocating kidneys was believed to affect hospitals that had the sole Transplant Center for that DSA disproportionately. The study was performed to assess whether promoting regional organ sharing led to changes in volume and outcomes of one such transplant center.
Methods: UNOS organ allocation policy for kidneys changed on March 15, 2021. We reviewed our transplant center data for transplants performed prior to that date, and those performed between March 15, 2021 and December 1, 2022. We studied the data for metrics including the number of transplant performed, the rate of transplantation per year, organ quality based on KDPI scores, cold ischemic times,dual kidney transplants, rate of delayed graft function, hospital length of stay, renal function at 1 year posttransplant, patient and graft survival at 1 year. All metrics were compared between the 2 eras using the T paired test and Chi- square test. A P- value of less than 0.05 is considered significant.
Results:
| Pre-allocation change | Post- allocation change | p-value | |
|---|---|---|---|
| n | 116 | 223 | |
| Rate of transplants/year | 149 | 138 | 0.40 |
| KDPI mean | 53 | 36 | <0.05* |
| Cold Ischemic time (minutes) | 886(14.7 hours) | 1404 (23.4 hours) | <0.05* |
| Dual kidney transplants | 1 | 32 | <0.05* |
| DGF | 42/116 (36%) | 100/223(44%) | 0.126 |
| LOS (days) | 5 | 5 | - |
| GFR mls/min at 12 months | 50.78∓9.53 | 54.20∓9.68 | 0.69 |
| 1 year death censored graft survival | 99.13% | 98.65% | 0.69 |
| 1 year patient survival | 99.13% | 97.3% | 0.26 |
*statistically significant
The transplantation rate decreased after the allocation policy change. There was a statistically significant increase in the cold ischemic times. Outcomes including delayed graft function length of stay, GFR at the end of 1 year, patient and graft survival remained unaffected largely due to an increase in dual kidney transplantation.
Conclusions: The kidney allocation policy change affected cold ischemic times for kidney transplants, however an increase in dual kidney transplantation mitigated a potential effect on transplant center outcomes.
