Survival and Quality of Life Impact of a Risk-based Allocation Algorithm for Deceased Donor Kidney Transplantation

Vaishnavi Calisa, Jonathan C. Craig, Kirsten Howard, Martin Howell, Stephen Alexander, Steven J. Chadban, Philip Clayton, Wai H. Lim, John Kanellis, Kate Wyburn, David W. Johnson, Stephen P. McDonald, Helen Opdam, Jeremy R. Chapman, Jean Yang, Germaine Wong

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4 Citations (Scopus)

Abstract

Background To determine the incremental gains in graft and patient survival under a risk-based, deceased donor kidney allocation compared with 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 QALYs and graft years between the 8 risk-based allocation strategies against current practice. Results Compared with current practice, Kidney Donor Risk Index-Estimated Posttransplant Survival matching of the lowest 20% of scores reduced median waiting time by 0.64 years (95% confidence interval [CI], 0.52-0.73) for recipients aged 30 years or younger, but increased waiting time by 0.94 years (95% CI, 0.79-1.09) for recipients older than 60 years. Among all age groups, the greatest gains occurred if Kidney Donor Risk Index-Estimated Posttransplant Survival 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 with the 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. Prioritization of lower-quality donor kidneys for older candidates reduced the waiting time for recipients older than 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 survivals, accrued through benefits for recipients 45 years or younger but disadvantage to recipients older than 60 years.

Original languageEnglish
Pages (from-to)1530-1537
Number of pages8
JournalTransplantation
Volume102
Issue number9
DOIs
Publication statusPublished - Sep 2018
Externally publishedYes

Keywords

  • donor kidneys
  • kidney transplantation
  • patient survival
  • quality of life

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    Calisa, V., Craig, J. C., Howard, K., Howell, M., Alexander, S., Chadban, S. J., Clayton, P., Lim, W. H., Kanellis, J., Wyburn, K., Johnson, D. W., McDonald, S. P., Opdam, H., Chapman, J. R., Yang, J., & Wong, G. (2018). Survival and Quality of Life Impact of a Risk-based Allocation Algorithm for Deceased Donor Kidney Transplantation. Transplantation, 102(9), 1530-1537. https://doi.org/10.1097/TP.0000000000002144