D. Sanchez1, D. Dubay1, P. Baliga1, D. J. Taber1 1Medical University Of South Carolina,Division Of Transplant Surgery,Charleston, Sc, USA
Introduction: To make kidney allocation for transplantation as effective and equitable as possible, a new Kidney Allocation System (KAS) was implemented on December 14, 2014. The purpose of this study was to assess the impact of KAS on perioperative outcomes and if changes differed by race/ethnicity.
Methods: This was a time series analysis using aggregated data acquired in monthly intervals from October 1, 2012 through September 30, 2015. The analysis included all data reported to the University HealthSystem Consortium (UHC) by accredited US Kidney Transplantation Centers for adult solitary kidney recipients of deceased donor transplants.
Results: The 35-month time frame included 25 months of pre-KAS data and 10 months of post-KAS data. A total of 28,809 deceased donor kidney transplants were included. After KAS implementation, the estimated transplant rate per month decreased significantly for Caucasians by 17.6 cases per month (p=0.0001, Figure 1), and increased significantly for AAs by 37.8 (p=0.0001), Hispanics by 16.3 (p=0.0001), and other races by 8.2 cases per month (p=0.0001). Delayed graft function (Figure 2), 7 and 14-day readmissions significantly increased after KAS, but this did not vary by race. Hispanics saw a 7.7% decrease in ICU admissions after KAS, which differed as compared to other racial/ethnic cohorts (p=0.0026). Costs increased significantly after KAS in all groups except Hispanics. Mortality, length of stay, in-hospital complications and 30-day readmissions were not significantly impacted by KAS.
Conclusion: These results demonstrate that KAS has substantially impacted transplant rates, which differed by race/ethnicity. KAS also led to increased costs, readmissions and DGF which did not differ by race. The impact of KAS on ICU cases, which was different in Hispanics requires further investigation into potential etiologies.
