1. 1 Kidney Transplantation Committee Spring 2016

2. 2 Recent Public Comment Proposals  OPTN Kidney Paired Donation (KPD) Priority Points  Changes apply only to the OPTN KPD program  Revisions to priority points (e.g. sliding scale for CPRA and donor/candidate blood type)  Remedy for candidates in a failed exchange  Board Approved: Dec. 2015  Implementation: Pending Programming

3. 3 Policy Implementation Dates  OPTN KPD Deadlines and Message Boards  Changes apply only to the OPTN KPD program  Programs deadlines for:  Match offer preliminary responses  Performing crossmatches  Providing and reviewing donor records  Total time from offer to final acceptance/refusal = 15 business days  Creates message boards for communication  Board Approved: June 2015  Estimated Implementation: Within 1 st half of 2016

4. 4 KAS Update Spring 2016

5.  KAS implemented Dec 4, 2014  Key goals:  Make better use of available kidneys  Increase transplant opportunities for difficult-to-match patients (increased equity)  Increase fairness by awarding waiting time points based on dialysis start date  Have minimal impact on most candidates Background

6.  Performance tracked monthly for first six months (“out of the gate” reports)  Comprehensive, 6-month analysis provided to the kidney committee in Sep 2015  One year analysis requested by the committee (analyses underway)  Pre-KAS period: Dec 4, 2013 – Dec 3, 2014 (12 months)  Post-KAS period: Dec 4, 2014 – Dec 3, 2015 (12 months)  Solitary, deceased donor kidney transplants  This slide set contains highlights from the full one-year report Background

7. Trends in kidneys recovered and transplanted ↑ 4.6% ↑ 6.2% Kidneys recovered for transplant Solitary kidney transplants  Nearly 1,000 more deceased donor kidneys were recovered post- KAS, and nearly 500 more transplants occurred.

8. Who’s getting transplanted under KAS? Percentage of Deceased Donor Kidney Transplants by Recipient Age  More young candidates (18-49) are receiving kidney transplants.  Transplants to pediatrics rebounded in 2 nd six months

9. Who’s getting transplanted under KAS? Percentage of Deceased Donor Kidney Transplants by Recipient Race/ethnicity  More African Americans are receiving kidney transplants, although less so during the 2 nd six months.

10. Who’s getting transplanted under KAS? Percentage of Deceased Donor Kidney Transplants by Recipient Blood Type  The distribution of transplants has changed little by recipient ABO.  Slight increases for blood type B and AB patients.

11. Who’s getting transplanted under KAS? Percentage of Deceased Donor Kidney Transplants by Recipient CPRA  Transplants increased sharply for CPRA 99-100% patients but have tapered during the 2 nd six months.

12. Who’s getting transplanted under KAS? Percentage of Deceased Donor Kidney Transplants by Recipient Duration on Dialysis  More transplants are going to long dialysis duration recipients.  Fewer preemptive (before dialysis) transplants.

13. Geographic distribution of kidney transplants  More kidneys are being distributed outside recovery OPO’s DSA.  CIT>24 hours: Pre-KAS 18.2%, Post-KAS 21.6%. 21.4% 31.5%

14. Geographic distribution of kidney transplants  The distribution of transplants by OPTN region has changed little.

15. Kidney recovery under KAS  The distribution of recovered kidneys by KDPI has remained very similar. Percentage of Recovered Deceased Kidney Donors by KDPI

16. Kidney recovery & utilization under KAS  Discard rates initially rose during 1 st six months... Kidney Discard Rate by KDPI

17. Kidney recovery & utilization under KAS ... but subsequently stabilized. Further tracking and study underway. Kidney Discard Rate by KDPI

18.  0 ABDR mismatches declined from 8.2% to 4.7% of transplants  22% fewer transplants with 30+ year donor/recipient age difference  Delayed graft function (DGF) rates increased from 24% to 30%.  Six month graft survival rates* remain statistically unchanged (p=0.13)  Pre-KAS: 95.8%  Post-KAS: 95.2% Other findings * Based on the first 4 months of post-KAS transplants

19.  Overall – KAS is meeting key goals  Increase highly sensitized recipients; tapering effect observed  Increase in access for African Americans and high dialysis time recipients, also with tapering observed  Fewer longevity mismatches  Transplant volume is up nearly 5%  Several effects deserve further attention:  Logistical challenges in allocation, increased CIT  Discard rates  Increased DGF; early graft survival rates statistically unchanged (but small N) Summary: First Year of KAS

20. Mark Aeder, MD Committee Chair Mark.Aeder@uhhospitals.org Melinda Woodbury Committee Liaison Melinda.Woodbury@unos.org Questions? 20