New kidney offering scheme … Lorna Marson Deputy Chair, Kidney Advisory Group Work in progress

New kidney offering scheme Philosophy of allocation New offering scheme design group Final allocation design groupNew allocation policy H&I considerations

New offering scheme design group Lorna Marson (Chair) Lisa Bradbury Chris Callaghan Peter Friend Sue Fuggle Paul Gibbs Rachel Johnson Stephen Marks Phil Mason Adam McLean Gabriel Oniscu Nick Torpey Colin Wilson Chris Watson

Terms of Reference To review the outcomes of the 2006 allocation scheme To evaluate the appropriateness of centre differences in acceptance criteria To determine the place of ischaemic time minimisation in a new allocation scheme. To determine the extent to which donor organ quality should relate to recipient parameters

Summary of KAS 2006 Whilst the centre-specific variation in waiting time has reduced – Systematic reduction in access to transplantation for ABO-O recipients – Ratio of transplants: donors is low in BAME groups – Highly sensitised patients with >85% cRF are disadvantaged – Particularly affecting patients with cRF 100%

Workstreams Transplanting the very highly sensitised patient The challenge of blood group and ethnicity Assessing donor quality Assessing recipient quality

Transplanting the very highly sensitised patient Centre variation in listing Variation in acceptance of kidneys – Review 100% HSP on list – Flag if declined Identify patients who are likely to wait 7 years from day 1 Consider ‘acceptable mismatch’ Increase in points from 50% upwards rather than from >85%

Donors ABO-OABO-A ABO-BABO-AB Transplants Blood group trends

ABO-O donor kidneys shared with 000 very HSP ABO-A & AB patients plus all ABO-B patients No payback for ABO-O recipients Systematic reduction in access to transplant for ABO-O recipients Blood group matching rules

Tx List White Transplants Asian Black Other Ethnicity trends

How can we help BAME and blood group O patients? Possible solutions: Better matching in allocation Allow antibody incompatible deceased donor transplants Limit allocation of blood group O donors What future analysis can be performed?

Assessing donor quality New UK Kidney Donor Risk Index – Data from 5166 first adult kidney only recipients – January 2006-December 2010 Datasets – Modelling 3100 (60%) – Validation 2066 (40%) Multiple donor, recipient and transplant demographics included

Donor factors affecting survival Age Ethnicity Height History of hypertension Gender Considered over three time frames: 0-3 months, 3 months to 3 years, >3 years

New UK Kidney Donor Risk Index NUKKDRI=exp { x (donor age-50) x (Asian donor ethnicity) x (Black donor ethnicity) x (Other donor ethnicity) x ([donor height-170]/10) x (history of hypertension) x (female donor) } NUKKDRI+1 for a 170cm white male donor with no history of hypertension 1 higher risk donor

Other donor indices UKKDRI USKDRI Similar predictive ability Fewer donor factors than USKDRI Linear term for donor age Plan to now to validate with larger data set

1yr graft1yr patient5yr graft5yr patient10yr patient from listing Donor age Donor type Donor cause of death Graft year Cold ischaemia time HLA mismatch group Waiting time Primary renal disease Recipient ethnicity Recipient age Recipient gender Recipient blood group Recipient BMI Recipient cRF>85% Recipient dialysis status Factors found to significantly affect survival: Assessing recipient quality

Acknowledgements Chris Watson, Chair of KAG All members of working group LISA BRADBURY