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NEW YORK, March 28, 2019 / PRNewswire / – The country's kidney allocation system (KAS) may need reform, according to an article published today in the American Journal of Kidney Diseases (AJKD), the official journal of the National Kidney Foundation (NKF).
The authors of "Allocation of the highest quality kidneys and transplant results in the new kidney allocation system" investigated how the effect of donor quality on post-transplant outcomes is similar regardless of the degree of antigen sensitization in patients. They found that highly sensitized and non-sensitized recipients have similar initial graft results with a high quality kidney. In addition, the initial results are worse in both groups with a lower quality kidney.
"We are concerned that the disproportionate use of high quality kidneys in highly sensitized candidates removes these kidneys from less sensitized candidates, which could impact post-transplant outcomes in less sensitized individuals." , said the principal investigator. Edmund Huang, MD.
The investigators studied how the current practice of KAS creates a disproportionate number of kidneys of the highest quality attributed to the sensitized group, even though the aim of the KAS was to preferentially give these kidneys to those who would benefit the most, according to Dr. Huang. The authors point out that the KAS system may have provided transplant opportunities for the most sensitive recipients via regional and national allocation priorities. The system does not account for the anticipated decrease in long-term graft survival in this population compared to the often younger, non-sensitized candidates. Post-transplant survival estimates (EPTS)
KAS aims to ensure a fair distribution of deceased donor kidneys in the United States. The current version was implemented in 2014 after a 10-year study conducted by OPTN Transplant Kidney Transplantation, according to the US Department of Health and Human Services.
The last KAS method increased the allocation priority of all deceased donor kidneys to highly sensitized candidates, as these patients were rarely transplanted prior to the 2014 KAS review because of the difficulty in finding an acceptable cross-match. However, according to the article's investigators, it appears that KAS may have over-compensated and over-prioritized for transplant centers to now be able to selectively select organs of the highest quality.
"Increase in the use of kidneys with the bottom [kidney donor profile index] Scores in highly sensitized recipients decrease the availability of these organs for other patients on the waiting list, many of whom could hope to have better survival after transplantation, "wrote the investigators in the article. . " Will changes in allocation policy affect long-term treatment? Graft survival in less sensitized recipients and the entire transplant population should be evaluated in future studies, when longer-term data become available. "
"This review by Huang and colleagues highlights the results of the most recent kidney badignment system and the current need to more effectively use the kidneys of deceased donors and limit kidney rejections." of deceased donors, "said Dr. Joseph Vbadalotti, Chief Medical Officer of the NKF. "As all the previous organ allocation systems have demonstrated and the current UNOS policy proposals regarding a new attribution system, the persistent shortage of funding is still a problem. given organs gives difficult decisions in terms of equitable access, often at the expense of optimal use and / or survival of the kidney. "
Investigators reviewed thousands of cases collected from October 2009 until that September 2017 through the United Nations Organ Supply and Transplant Network / United Network for Organ Sharing. Investigators say the system needs further study before proposing changes to KAS.
Information about the article
The article is published online and open to everyone for 90 days. It will only be available to AJKD subscribers. Access the article by going to https://www.ajkd.org/article/S0272-6386(19)30056-3/fulltext.
The investigators are Sethi Supreet MARYLAND, Reiad Najjar MARYLAND, Alice Peng MD, James Mirocha MS, Ashley Vo PharmDSuphamai Bunnapradist MD, Stanley C. Jordan MD and Dr. Huang. They are affiliated with the Division of Nephrology, Department of Medicine, Comprehensive Transplant Center, Cedar Sinai Medical Center, West Hollywood. Dr. Bunnapradist is also affiliated with the Division of Nephrology of the UCLA Kidney and Pancreas Transplant Department of Medicine. University of California at Los Angeles David Geffen School of Medicine.
About the American Journal of Kidney Disease
the American Journal of Kidney Diseases (AJKD), the official journal of the National Kidney Foundation, is recognized around the world as a leading source of information on the practice of clinical nephrology and clinical research. Articles selected for publication in AJKD must adhere to rigorous standards that support the purpose of the journal, which is to communicate important new information in clinical nephrology in order to strengthen knowledge and badist physicians in providing patient care the highest quality possible.
Professional membership at the NKF
Health Professionals Can Join NKF to Access Patient and Professional Tools and Resources, Discounts on Professional Education and a Network of Thousands of People Treating Patients With Kidney Disease .
Facts about kidney disease
In United States It is estimated that 30 million adults suffer from chronic kidney failure – and most do not know it. One in three American adults is at risk for chronic kidney disease. Risk factors for kidney failure include diabetes, hypertension, heart disease, obesity, and family history. People of African American, Hispanic, Native American, Asian or Pacific Island descent are at increased risk of developing the disease. African-Americans are three times more likely than whites, and Hispanics are nearly 1.5 times more likely than non-Hispanics to develop end-stage renal failure (renal failure).
The National Kidney Foundation (NKF) is the largest, most comprehensive and oldest patient-centric organization dedicated to raising awareness, preventing and treating kidney disease in the United States. For more information on the NKF, visit the website www.kidney.org.
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