Evaluation and Simulation of a Deceased Donor Kidney Allocation Score Before its Implementation. The Catalan Experience. (August 2017)

• Record Type: Journal Article
• Authors: Comas, Jordi; Garcia, Anna; López, Pedro; Sanromà, Marga; Tort, Jaume
• Is Part Of: Transplantation. Volume 101(2017)Supplement 8S-2
• Publication Date: 2017-08
• Subjects: Transplantation of organs, tissues, etc -- Periodicals; Transplantation immunology -- Periodicals; 617.95
• DOI: 10.1097/01.tp.0000525025.53023.0f
• Languages: English
• ISSNs: 0041-1337

Abstract

Abstract : Introduction: Several countries have implemented their own kidney allocation policies to ensure the equity, transparency and patient benefit in the waiting list. In Catalonia, a new kidney allocation model is planned to be implemented during 2017, and a new score has been developed to prioritize the recipients. Three analyses were designed to better know that score: -Concordance retrospective analysis: would that score have chosen the same recipient as the clinician did? -Impact retrospective analysis: how would the recipient profile have changed if the new model were applied? -Prospective analysis: Has the concordance changed after providing the score only for information? Which are the causes for not choosing the recipient with the highest score? Methods: Data from the registries of the Catalan Transplant Organization were used. All the effective kidney offers from January 2014 to June 2016 and the daily recipients active on the deceased donor renal waiting list were considered for retrospective concordance (n = 955) and impact analysis (n = 1.046). The effective kidney offers from December 2016 to March 2017 were used for the prospective analysis (n = 98). Results: In the concordance analysis, 282 (29.5%) kidney transplants (KT) were performed to a patient within the top 25th percentile values of the score. In the impact analysis, comparing the 1.046 KT performed with the 1.046 theoretical KT that would be performed using the new kidney allocation model, we observe an increase of mean time on dialysis (from 36.3 to 57.2 months) and cpra I + II mean (from 51.6% to 64.9%), a decrease of the mean age from 59.2 to 57.9 years and a reduction of first KT from 89.2% to 76.2%. The territorial variability would have been reduced from RV5-95 = 5 to RV5-95 = 3.5. In the 98 KT studied in the prospective analysis, concordance increased up to 65.3% (recipient within the 25th percentile). The main causes for not choosing the recipient with the highest value were the disagreement with the candidate (50.3%), immunologic causes (13.2%) and errors with the status of the recipient in the waiting list (21.9%). Conclusion: Although the concordance between the clinician and the developed score was initially low, it increased significantly after providing the waiting list sorted by that score. The main causes for not choosing the first recipient are avoidable and force us to make some changes before the implementation. Changes in the recipient profile and territorial equity observed in the impact analysis were the expected and desired ones. Advisory committee of kidney and pancreas transplantation.