Banga, N

Fernando, R

Howes, N

Jones, G

Motallebzadeh, R

Stephens, H

Syed, A

Ugwu, F

English

UCL Discovery

Single centre early experience of the new UK deceased donor kidney allocation scheme​ Noah Howes, Francis Ugwu, Asim Syed, Raymond Fernando, Henry Stephens,  Neal Banga, Gareth Jones, Reza Motallebzadeh Introduction  In July 2019 the Kidney Advisory Group on behalf of NHS Blood and Transplant published a new transplant offering scheme for deceased donor kidneys. The new scheme was introduced to address some of the inequities in the offering process. It aims to better match patients with graft life expectancy and facilitate greater priority for difficult to match patients. We present our unit’s experience of the new scheme since its introduction in September 2019. Methods  We retrospectively interrogated our local database  over a 4 month period from the date of the new scheme (11 September 2019) to the present (9 February 2020).  Results  Since commencement of the new allocation scheme a total of 44 deceased donor kidney transplants were performed in our centre (Table 1). 66% of our recipient cohort came from a BAME background, compared to 51.7% in the preceding year.  Based on the new allocation system, the distribution of tier A and tier B recipients is shown in table 2.          Of the tier A patients one had biopsy-proven mixed cellular and vascular rejection.   Of the tier B patients, who had a median of 8 HLA mismatches, 8.82% (3/44) developed either cellular (n=2) or antibody-mediated (n=1) rejection. See table 3.        There was one graft failure at 6 months. Mean eGFR for the cohort is shown in table 4.   Discussion  This preliminary study gives an indication of the age, matchability, and complexity of patients that have been transplanted as a result of the new national kidney offering scheme.  Longer follow up is required to further understand the long-term implications of the new allocation scheme, but the early data implies BAME recipients might achieve more equitable access to transplantation. This is of particular importance for our centre, where BAME patients account for over half of our centre’s current waiting list.  Total number of cases 44 Median recipient age (years)   53.5 (IQR 40.25-59.25) Male sex, n(%) 26 (59%) Ethnicity non-Caucasian, n(%) 29 (66%) Median time on waiting list (years) 3.32 (IQR 2.05-4.31) No of Transplant 1st 32 (73%) 2nd 11 (25%) 3rd 1 (2%) DBD/DCD, n(%) 29 (66%), 15 (34%) Number of ECD donors 12 (27%) Median cold ischaemic (hours) 10.7 (IQR 9-13.6) Match points, median (IQR)   8 (IQR 7.75-9) Total number of HLA mismatches, median (IQR) 8.5 (IQR 7-11) Number of Tier A mismatches, n(%) 10 (23%) Number of Tier B mismatches, n(%) 34 (77%) Sensitisation status at transplantation Not sensitised 23 (52%) n(%) Sensitised 14 (32%)   Highly sensitised 7 (16%) Biopsy-proven rejection % 4/44 (9%) 3 month eGFR mean (+/- SD) 51.2 (SD 19)   Median matchability score Number of cadaveric transplants Cases of biopsy-proven rejection Tier A 10 10 1 Tier B 8 34 3 Total  - 44 4 Table 1.  Table 2.  Table 3.  Table 4.  

Single Centre Early Experience of the New UK Deceased Donor Kidney Allocation Scheme

https://discovery.ucl.ac.uk/10098428/1/Changes%20in%20allocation%20scheme%20final.pdf

Single Centre Early Experience of the New UK Deceased Donor Kidney Allocation Scheme

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UCL Discovery