Kidney Transplantation Committee Update

1. Kidney Transplantation Committee Update John J. Friedewald, MD Committee Chair Meetings

2. Ongoing Projects • Progress to develop a new national kidney allocation system • Recommendations regarding variances • Kidney Paired Donation

3. National Kidney Allocation System

4. Progress Update • Simulation modeling completed and results reviewed by Committee • Objectives for a new system were met (limitations of current system addressed) • Committee voted to send out a policy proposal in the fall

5. Current Working Model • Patients rank ordered by • Waiting /ESRD time • DR matching • Sliding scale CPRA • System features • A2 -> B • Broader sharing CPRA>=98% • Patients rank ordered by • Waiting/ESRD time • System features • Regional sharing • A2 -> B • Broader sharing CPRA>=98% Top 20 % KDPI to Top 20 % EPTS Allocation under “current rules” (All Candidates) Opt in system of highest 15% KDPI kidneys “Think improved ECD” 0--------------------------------20-------------------------------------------------85------------------------100 KDPI Scale

6. Addressing System Limitations

7. Simulation Modeling Results

8. Summary Table

9. Kidney Transplants by Recipient Blood Type

10. Kidney Transplants by Recipient Age To Table

11. Kidney Transplants by Recipient Race

12. Kidney Transplants by 0 HLA mismatches

13. Kidney Transplants by Organ Sharing

14. Kidney Transplants by Recipient CPRA, with waitlist prevalence To Table

15. N3 versus N4 N3 N4 • Local CPRA 100 • Regional CPRA 100 • National CPRA 100 • Local CPRA 99 • Regional CPRA 99 • Local CPRA 98 • first priority for all kidneys • Local CPRA 98-100 • Regional CPRA 98-100 • National CPRA 98-100 • first priority for all kidneys

16. Kidney Transplants by Recipient cPRA, 95-100 To Table

17. Kidney Transplants by Recipient CPRA To Table

18. Projected median patient years of life per transplant: average, minimum, maximum of runs

19. Projected median graft years per transplant: average, minimum, maximum of runs

20. Projected LYFT per transplant:average, minimum, maximum of runs

21. Variance Review Process

22. Variances Reg 1 PADV PATF VATB OKOP TXSB TXGC The Committee received rationales from the above OPOs wishing to keep existing variances in the new allocation system

23. Variance Recommendations • Discontinuation of all variances except for • Dialysis waiting time study • A2/A2B • Align changes to take place at the time a new kidney allocation system is implemented • Allow applications for transition • Recommendations will be circulated for public comment in the fall

24. Timeline for KAS and Variance Proposals

25. Kidney Paired Donation Pilot Program Update

26. Overall Match Run Results

27. Barriers and Potential Solutions • Centers refusing matches based on combinations of low-level antibodies • Donor Pre-Select Tool • Frequency of match runs • Now running matches twice a month • Will increase frequency as resources allow but ultimate flexibility depends on automation of the match run

28. Barriers and Potential Solutions • Sizes of exchanges • Testing a smaller exchange size (chain cap of 4) in June match runs

29. June 12, 2012 Match Run Results (#22)

30. KPD Work Group Activities

31. KPD Policy • Two proposals completing public comment: • KPD Policy to replace Operational Guidelines • Comments focused on histocompatibility section and whether the program is ready for policy language • Bridge Donor Proposal • Public comment supportive of including bridge donors • Both proposals likely to be forwarded to the Board in November 2012

32. KPD Automated Solution Update

33. Pre-Match Data Entry Screens • Released on December 12, 2011 • Included the ability to: • Enter KPD application from UNet℠ • Add and maintain donors and candidates • Search for donors and candidates • Verify ABO • Print records

34. Eligibility Processing • Released on May 24, 2012: • Allows users to view whether candidates and donors are eligible for the next match run in real time • Includes warning messages for potential data entry errors

35. Feedback from Users • “I really like the app and think it's user interface should set the standard for other programs.  It's a great first step.” • “The addition of eligibility status to the UNet KPD module is a HUGE benefit! I love it that it now tells what is still missing, so we don't have to go hunting for it. Will try to get some more pairs ready for next week's match run. "

36. Future Functionality • Donor pre-select tool • Automation of the match run • Display of match results • Tracking of match responses

37. Questions?

38. Backup Slides

39. Counts of Kidney Transplants by Recipient CPRA Back To Figure

40. Counts of Kidney Transplants by Recipient CPRA, 95+ Back To Figure

41. Counts of Kidney Transplants, by Recipient Age Back To Figure

42. Sharing by cPRA 98+

43. Sharing by 0mm

44. Pediatric and Adult Transplants by Sharing

45. Adult and Pediatric Transplants by Top 20/Bottom 80

46. Top 20 recipients by HLA-mismatch

47. Sharing by run • N2 projects a similar amount of sharing as N1 • N3 projects fewer local transplants than N1

48. Sharing by run, continued • N4 projects fewer local transplants than N1 • N4 projects more local transplants than N3