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Purpose: We report the consequences of a novel kidney
allocation system on access of Non-Caucasians (NC) to kidney transplantation
(KTx). The new plan has provided a balance between time waiting, HLA match,
PRA, and geography (population distance between donor and recipient
center).
| Methods: This report compares 3 sequential systems of Regional allocation: | |||
| Criteria | Period I (9.94-9.96) | Period II (9.96-11.97) | Period III (12.97-11.98) |
| HLA points | 0 B/DR mm | 0-2 B/DR mm | 0 B/DR mm only |
| Geography | local units (OPO) | Pop Dist (OPO) | Pop Dist (Region) |
| Results: | NC % of WAIT LIST vs NC % of KTx | |||||
| Region | region | Region | UNOS | UNOS | UNOS | |
| Period | I | II | III | I | II | III |
| Wait List | 27.1% | 27.6% | 30.6% | 50.0% | 50.0% | 51.3% |
| Transplants | 19.3% | 22.7% | 24.9% | 39.5% | 39.5% | 40.3% |
This allocation plan (Period II & III) has increased the NC KTx rate closer to the NC proportion on the wait list, comparatively exceeding the national UNOS data. There was no statistical difference in Regional mean wait time between Cauc.(C) and NC. We also analyzed the HLA effect of moderate degrees of intentional matching (0-2 B/DRmm) by race and at racial distribution within poorly matched transplants (>2 B/DRmm) to determine the HLA independent effect of allocation.
| RACIAL DISTRIBUTION WITHIN 0-2 HLA-B/DR MISMATCHED KTx | |||
| Period I | Period II | Period III | |
| NC/Totla 0-2B/DRmm KTx | 21.3% | 27.4% | 21.9% |
| C/Total 0-2B/DRmm KTx | 78.8% | 72.6% | 78.1% |
| RACIAL DISTRIBUTION WITHIN >2 HLA-B/DR MISMATCHED KTx | |||
| Period I | Period II | Period II | |
| NC/Total >2B/DRmm KTx | 23.9% | 26.3% | 30.2% |
| C /Total >2B/DRmm KTx | 76.1% | 73.7% | 69.8% |
Improvements in access to Tx for NCs between Period I
and Periods II & III appear to be related to changes in geographic
allocation weight from local unit to population distance points, and to
inclusion of the entire Region in the plan.. Despite increased proportion of
NCs on the wait list from Period I to II & III, the gap between the NC wait
list and NC transplants fell from 7.8% to 5.4%. Conclusions: These data
demonstrate that this new allocation plan improves access of minority
candidates to transplantation. Moderate HLA matching does not hurt NCs;
however, the broadening of geographic allocation appears to permit a more
favorable opportunity for renal transplantation to NC candidates.
Key words: Minority Renal Allograft Allocation