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

Research output: Contribution to journalArticle

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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 - 1 Sep 2018

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Kidney Transplantation
Quality of Life
Tissue Donors
Survival
Kidney
Graft Survival
Confidence Intervals
Transplants
Quality-Adjusted Life Years
Statistical Models
Age Groups

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Calisa, V., Craig, J. C., Howard, K., Howell, M., Alexander, S., Chadban, S. 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
Calisa, Vaishnavi ; Craig, Jonathan C. ; Howard, Kirsten ; Howell, Martin ; Alexander, Stephen ; Chadban, Steven J. ; Clayton, Philip ; Lim, Wai H. ; Kanellis, John ; Wyburn, Kate ; Johnson, David W. ; McDonald, Stephen P. ; Opdam, Helen ; Chapman, Jeremy R. ; Yang, Jean ; Wong, Germaine. / Survival and Quality of Life Impact of a Risk-based Allocation Algorithm for Deceased Donor Kidney Transplantation. In: Transplantation. 2018 ; Vol. 102, No. 9. pp. 1530-1537.
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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.",
author = "Vaishnavi Calisa and Craig, {Jonathan C.} and Kirsten Howard and Martin Howell and Stephen Alexander and Chadban, {Steven J.} and Philip Clayton and Lim, {Wai H.} and John Kanellis and Kate Wyburn and Johnson, {David W.} and McDonald, {Stephen P.} and Helen Opdam and Chapman, {Jeremy R.} and Jean Yang and Germaine Wong",
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Calisa, V, Craig, JC, Howard, K, Howell, M, Alexander, S, Chadban, SJ, Clayton, P, Lim, WH, Kanellis, J, Wyburn, K, Johnson, DW, McDonald, SP, Opdam, H, Chapman, JR, Yang, J & Wong, G 2018, 'Survival and Quality of Life Impact of a Risk-based Allocation Algorithm for Deceased Donor Kidney Transplantation' Transplantation, vol. 102, no. 9, pp. 1530-1537. https://doi.org/10.1097/TP.0000000000002144

Survival and Quality of Life Impact of a Risk-based Allocation Algorithm for Deceased Donor Kidney Transplantation. / Calisa, Vaishnavi; Craig, Jonathan C.; Howard, Kirsten; Howell, Martin; Alexander, Stephen; Chadban, Steven J.; Clayton, Philip; Lim, Wai H.; Kanellis, John; Wyburn, Kate; Johnson, David W.; McDonald, Stephen P.; Opdam, Helen; Chapman, Jeremy R.; Yang, Jean; Wong, Germaine.

In: Transplantation, Vol. 102, No. 9, 01.09.2018, p. 1530-1537.

Research output: Contribution to journalArticle

TY - JOUR

T1 - Survival and Quality of Life Impact of a Risk-based Allocation Algorithm for Deceased Donor Kidney Transplantation

AU - Calisa, Vaishnavi

AU - Craig, Jonathan C.

AU - Howard, Kirsten

AU - Howell, Martin

AU - Alexander, Stephen

AU - Chadban, Steven J.

AU - Clayton, Philip

AU - Lim, Wai H.

AU - Kanellis, John

AU - Wyburn, Kate

AU - Johnson, David W.

AU - McDonald, Stephen P.

AU - Opdam, Helen

AU - Chapman, Jeremy R.

AU - Yang, Jean

AU - Wong, Germaine

PY - 2018/9/1

Y1 - 2018/9/1

N2 - 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.

AB - 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.

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U2 - 10.1097/TP.0000000000002144

DO - 10.1097/TP.0000000000002144

M3 - Article

VL - 102

SP - 1530

EP - 1537

JO - Transplantation

JF - Transplantation

SN - 0041-1337

IS - 9

ER -