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Preemptive Kidney Transplants Up After KAS Implementation

FRIDAY, Sept. 27, 2019 -- Disparities persist in preemptive kidney transplantation, where a patient does not receive dialysis before transplant, despite introduction of the new Kidney Allocation System (KAS) in 2014, according to a study published online Sept. 26 in the Clinical Journal of the American Society of Nephrology.

Kristen L. King, M.P.H., from the Columbia University Irving Medical Center in New York City, and colleagues examined trends in preemptive deceased donor transplantation with the introduction of KAS in 2014. Deceased donor kidney transplant recipients were identified from 2000 to 2018.

The researchers observed an increase in the proportion of preemptive transplants after KAS implementation, from 9.0 to 9.8 percent, with the odds of preemptive transplantation 1.10 times higher after versus before KAS. Recipients of preemptive transplantation were more likely to be white, older, female, more educated, privately insured, and have a cause of end-stage kidney disease other than diabetes or hypertension. The correlation between preemptive transplantation and race, age, insurance status, and Human Leukocyte Antigen zero-mismatch was modified by policy era. Compared with private insurance holders, Medicare patients had significantly lower odds of preemptive transplantation, as did black and Hispanic versus white patients.

"Significant disparities in preemptive kidney transplantation persist and appear to have been exacerbated after KAS, especially regarding race and insurance, despite an overall increase in the proportion of kidneys transplanted preemptively," the authors write.

Two authors disclosed financial ties to the pharmaceutical industry.

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Posted: September 2019

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