Survival and quality of life impact of a risk-based allocation algorithm for deceased donor kidney transplantation

Background To determine the incremental gains in graft and patient survival under a risk-based, deceased donor kidney allocation compared to the current Australian algorithm. Methods Risk-based matching algorithms were applied to first graft, kidney only recipients (n=7513) transplanted in Australia between 1994 and 2013. Probabilistic models were used to compare the waiting time, life and quality-adjusted life years and graft years between the 8 risk-based allocation strategies against current practice. Results Compared to current practice, KDRI-EPTS matching of the lowest 20% of scores reduced median waiting time by 0.64 years (95% CI: 0.52–0.73) for recipients aged ≤ 30 years, but increased waiting time by 0.94 years (95% CI: 0.79 – 1.09) for recipients aged > 60 years. Among all age groups, the greatest gains occurred if KDRI-EPTS matching of the lowest 30% of scores was used, incurring a median overall gain of 0.63 (95% CI: 0.03–1.25) life years and 0.78 (95% CI: 0.30 – 1.26) graft years compared to current practice. A median gain in survival of 1.91 years for younger recipients (aged 30–45 years) was offset by a median reduction in survival (by 0.95 life years) among the older recipients. Prioritisation of lower quality donor kidneys for older candidates reduced the waiting time for recipients aged > 45 years, but no changes in graft and patient survivals were observed. Conclusions Risk-based matching engendered a moderate, overall increase in graft and patient survival, accrued through benefits for recipients aged ≤ 45 years but disadvantage to recipients aged > 60 years. Corresponding author: Germaine Wong, Sydney School of Public Health, The University of Sydney, Camperdown, 2006 Australia. Email: germaine.wong@health.nsw.gov.au Acknowledgments We would like to thank all clinicians, nurses, patients and clinical research staff who have contributed data to the Australia and New Zealand Dialysis and Transplant Registry. Funding: The study is funded by the BEAT-CKD Program Grant (APP1092579). Contributors: VC and GW had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analyses. VC and GW conceived and designed the study. All authors acquired and interpreted the data, revised the manuscript, and gave final approval of the manuscript. VC and GW drafted the manuscript. VC and GW and JY were responsible for the statistical analyses and the figures. Disclosure: No authors have any financial relationships with any organisations that might have any interests in the submitted work, and no other relationships or activities that may have influenced the conduct of the submitted work. Ethical approval: Only de-identified data were used. Ethics approval for this study was not required. Copyright © 2018 Wolters Kluwer Health, Inc. All rights reserved.

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