The Deceased Donor Kidney Allocation System. 123,208 organ tx candidates are on the waiting list...

The Deceased Donor Kidney Allocation System

123,208 organ tx candidates are on the waiting list

101,603 are waiting for a kidney tx

As of February 15…

Waiting time calculation

• Pre-registration dialysis time added

Candidate classification

• Estimated Post Transplant Survival Score (EPTS)

Kidney donor classification

• Replace SCD/ECD with Kidney Donor Profile Index (KDPI)

Overall Changes to Allocation System

Recent Allocation Component Changes

Priority for sensitized

candidates

• Calculated panel reactive antibody (CPRA) sliding scale, regional/national sharing for CPRA greater than 98%

Pediatric kidney

allocation• KDPI priority

Blood type eligibility

• A2 and A2B to B compatible

Kidney candidate

priority

Priority points

Match classification (position on

the match run)

Candidate Priority

Sequence AKDPI <=20%

Sequence BKDPI >20% but

<35%

Sequence CKDPI >=35% but

<=85%

Sequence DKDPI>85%

Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)

Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults

Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational

Highly Sensitized0-ABDRmmLocal + Regional National

Waiting Time Points

Dialysis start date

Date after registration that eGFR is at or

below 20 mL/mn

Waiting Time Points Priority

*Peds begin accruing waiting time at listing regardless of clinical factors

Waiting Time QualifiersDialysis• Determined by listing center• Waittime may start prior to listing• Multiple centers may have equal waittime points• Acceptable methods of documentation

• 2728, dialysis center letter, physician note

GFR/Cr Clearance• Determined by listing center• Waittime can only start at or after candidate is listed• Only one center can have longest waittime points• Acceptable methods of documentation

• Laboratory

Multiple DSAs listingAccess to different local donor poolCompleting with different candidates

Multiple local listingsAlternate clinical interventions availableDifferent acceptance rates and parameters

Multiple Listing with Dialysis as the Waittime Qualifer

Estimated Post Transplant Survival

EPTS score range 0%-100%

Time on dialysis

Candidate’s age

Any prior solid organ

transplant

Current diagnosis

of diabetes

EPTS Match Classification Priority

EPTS score used to identify two groups of patients*

Those with scores of 0-20%

Those with scores of 21-100%

*The top 20% EPTS is calculated based on a national pool of candidates from a certain time period.

Kidney Donor Profile Index

KDPI based on:

Donor age

Height

Weight

Ethnicity

History of hypertension

History of diabetes

Cause of death

Serum creatinine

Hepatitis C virus status

Donation after circulatory death

• KDPI scores range from 0-100%• Lower KDPI is associated with better

longevity

Using the KDPI to Predict Graft Survival

EPTS & KDPI in the New System

Longevity MatchingEPTS0-20%

KDPI0-20%

Candidate Points Report

National 20% EPTS

OHOU Blood Type O candidates 48 candidates that fall within the 20%

Sequence AKDPI <=20%

Sequence BKDPI >20% but

<35%

Sequence CKDPI >=35% but

<=85%

Sequence DKDPI>85%

Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)

Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults

Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational

Highly Sensitized0-ABDRmmLocal + Regional National

Sequence AKDPI <= 20%

Highly Sensitized (CPRA 98+)

0-ABDRmm (0-20% EPTS)

Prior living donor

Local pediatrics

Local (0-20% EPTS)

0-ABDRmm (21-100% EPTS)

Local (21-100% EPTS)

Regional Pediatrics

Regional (0-20% EPTS)

Regional (21-100% EPTS)

National Pediatrics

National (0-20% EPTS)

National (21-100% EPTS)

Based on unacceptable antigens listed for the candidate

Used to calculate how many donors will be incompatible with the candidate

Ranges from 0-100%

CPRA score

CPRA Priority Points

CPRA

0 0 0 0.08 0.21 0.34 0.48 0.81 1.091.58 2.46

4.05

6.71

10.82

12.17

17.30

02468

101214161820

0 10 20 30 40 50 60 70 80 90 100

Po

ints

CPRA Sliding Scale (Allocation Points)(CPRA<98%)

CPRA

CPRA Match Classification PrioritySequence A

KDPI <=20%Sequence BKDPI >20% but

<35%

Sequence CKDPI >=35% but

<=85%

Sequence DKDPI>85%

Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)

Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults

Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational

Highly Sensitized0-ABDRmmLocal + Regional National

CPRA greater than 98%

Aged 0-10 at the time of the match run and 0-ABDR

mismatch with donor = 4 points

Aged 0-10 at the time of the match run and the donor’s

KDPI is less than 35% = 1 point

Aged 11-17 at time of the match run and a 0-ABDR

mismatch with donor = 3 points

Pediatric Status Points

Pediatric Match Classification Priority

Sequence AKDPI <=20%

Sequence BKDPI >20% but

<35%

Sequence CKDPI >=35% but

<=85%

Sequence DKDPI>85%

Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)

Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pedsRegional adultsNational pediatricsNational adults

Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational

Highly Sensitized0-ABDRmmLocal + Regional National

*Pediatric match classification priority is based on age at the time of registration (not time of the match run)

4 points with every registration

Prior Living Organ Donors

Sequence AKDPI <=20%

Sequence BKDPI >20% but

<35%

Sequence CKDPI >=35% but

<=85%

Sequence DKDPI>85%

Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)

Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults

Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational

Highly Sensitized0-ABDRmmLocal + Regional National

A zero HLA-DR mismatch with the

donor = 2 points

A single HLA-DR mismatch with the

donor = 1 point

HLA-DR matching priority points

HLA Match Classification Priority

Sequence AKDPI <=20%

Sequence BKDPI >20% but

<35%

Sequence CKDPI >=35% but

<=85%

Sequence DKDPI>85%

Highly Sensitized0-ABDRmm (top 20% EPTS)Prior living donorLocal pediatricsLocal top 20% EPTS0-ABDRmm (all)Local (all)Regional pediatricsRegional (top 20%)Regional (all)National pediatricsNational (top 20%)National (all)

Highly Sensitized0-ABDRmmPrior living donorLocal pediatricsLocal adultsRegional pediatricsRegional adultsNational pediatricsNational adults

Highly Sensitized0-ABDRmmPrior living donorLocal RegionalNational

Highly Sensitized0-ABDRmmLocal + Regional National

Rank-ordering of Candidates within each Match Classification

Total points determined by:Waiting time CPRA sliding scale

HLA-DR matching Pediatric status

Prior living donor status

Tiebreaker = date of registration

Transplant Pro Resources

Example of Resources

Chrystal Graybillchrystal.graybill@unos.org

804-782-4631

Questions?