{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T02:02:34Z","timestamp":1793325754215,"version":"4.5.0"},"reference-count":27,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","funder":[{"DOI":"10.13039\/100000062","name":"National Institute of Diabetes and Digestive and Kidney Diseases of the National Institutes of Health","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000062","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100000002","name":"National Institutes of Health","doi-asserted-by":"publisher","award":["K08DK119576"],"award-info":[{"award-number":["K08DK119576"]}],"id":[{"id":"10.13039\/100000002","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":["JASN"],"published-print":{"date-parts":[[2023,1]]},"abstract":"\n Significance Statement<\/jats:title>\n To reduce geographic disparities in kidney transplantation, the United States implemented a new model of deceased donor kidney allocation in March 2021. The new model\u2019s effect on transplant logistics and kidney utilization is unknown. Using data from the Scientific Registry of Transplant Recipients, this study found an increase in transplants among highly sensitized patients and patients with long dialysis duration. However, cold ischemia time after implementation of the new allocation policy increased significantly, with a suggestion of an increase in kidney discards. Given that the policy was implemented during the coronavirus disease 2019 pandemic, which also affected transplant practices, there is need for continued monitoring for potential unintended consequences of the new policy, along with efforts to mitigate them.<\/jats:p>\n <\/jats:sec>\n \n Background<\/jats:title>\n In March 2021, the United States implemented a new kidney allocation system (KAS250) for deceased donor kidney transplantation (DDKT), which eliminated the donation service area-based allocation and replaced it with a system on the basis of distance from donor hospital to transplant center within\/outside a radius of 250 nautical miles. The effect of this policy on kidney discards and logistics is unknown.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n We examined discards, donor-recipient characteristics, cold ischemia time (CIT), and delayed graft function (DGF) during the first 9 months of KAS250 compared with a pre-KAS250 cohort from the preceding 2 years. Changes in discards and CIT after the onset of COVID-19 and the implementation of KAS250 were evaluated using an interrupted time-series model. Changes in allocation practices (biopsy, machine perfusion, and virtual cross-match) were also evaluated.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n Post-KAS250 saw a two-fold increase in kidneys imported from nonlocal organ procurement organizations (OPO) and a higher proportion of recipients with calculated panel reactive antibody (cPRA) 81%\u201398% (12% versus 8%;\n P<\/jats:italic>\n <0.001) and those with >5 years of pretransplant dialysis (35% versus 33%;\n P<\/jats:italic>\n <0.001). CIT increased (mean 2 hours), including among local OPO kidneys. DGF was similar on adjusted analysis. Discards after KAS250 did not immediately change, but we observed a statistically significant increase over time that was independent of donor quality. Machine perfusion use decreased, whereas reliance on virtual cross-match increased, which was associated with shorter CIT.\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n Early trends after KAS250 show an increase in transplant access to patients with cPRA>80% and those with longer dialysis duration, but this was accompanied by an increase in CIT and a suggestion of worsening kidney discards.<\/jats:p>\n <\/jats:sec>","DOI":"10.1681\/asn.2022040471","type":"journal-article","created":{"date-parts":[[2022,10,27]],"date-time":"2022-10-27T11:05:42Z","timestamp":1666868742000},"page":"26-39","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":53,"title":["Early Effect of the Circular Model of Kidney Allocation in the United States"],"prefix":"10.1681","volume":"34","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4856-9242","authenticated-orcid":false,"given":"Chethan M.","family":"Puttarajappa","sequence":"first","affiliation":[{"name":"Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sundaram","family":"Hariharan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xingyu","family":"Zhang","sequence":"additional","affiliation":[{"name":"Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amit","family":"Tevar","sequence":"additional","affiliation":[{"name":"Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rajil","family":"Mehta","sequence":"additional","affiliation":[{"name":"Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vikraman","family":"Gunabushanam","sequence":"additional","affiliation":[{"name":"Department of Surgery, Thomas E. Starzl Transplantation Institute, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Puneet","family":"Sood","sequence":"additional","affiliation":[{"name":"Department of Medicine, Renal-Electrolyte Division, University of Pittsburgh, Pittsburgh, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"William","family":"Hoffman","sequence":"additional","affiliation":[{"name":"Transplant Nephrology, UPMC Pinnacle, Harrisburg, Pennsylvania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5305-9685","authenticated-orcid":false,"given":"Sumit","family":"Mohan","sequence":"additional","affiliation":[{"name":"Department of Medicine, Division of Nephrology, Vagelos College of Physicians and Surgeons and Department of Medicine, Mailman School of Public Health, Columbia University, New York, New York"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2022,10,27]]},"reference":[{"key":"B1-20260114","doi-asserted-by":"crossref","first-page":"1546","DOI":"10.1681\/ASN.2020121679","article-title":"New kidney and pancreas allocation policy: Moving to a circle as the first unit of allocation","volume":"32","author":"Israni","year":"2021","journal-title":"J Am Soc Nephrol"},{"key":"B2-20260114","doi-asserted-by":"crossref","first-page":"1174","DOI":"10.1681\/ASN.2020020121","article-title":"The broader sharing of deceased donor kidneys is an ethical and legal imperative","volume":"31","author":"Klarman","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"B4-20260114","doi-asserted-by":"crossref","first-page":"2007","DOI":"10.1111\/ajt.16441","article-title":"Greater complexity and monitoring of the new kidney allocation system: Implications and unintended consequences of concentric circle kidney allocation on network complexity","volume":"21","author":"Adler","year":"2021","journal-title":"Am J Transplant"},{"key":"B6-20260114","doi-asserted-by":"crossref","first-page":"1251","DOI":"10.1093\/ndt\/gfy010","article-title":"Machine perfusion and long-term kidney transplant recipient outcomes across allograft risk strata","volume":"33","author":"Sandal","year":"2018","journal-title":"Nephrol Dial Transplant"},{"key":"B7-20260114","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1056\/NEJMoa0802289","article-title":"Machine perfusion or cold storage in deceased-donor kidney transplantation","volume":"360","author":"Moers","year":"2009","journal-title":"N Engl J Med"},{"key":"B8-20260114","doi-asserted-by":"crossref","first-page":"2241","DOI":"10.1111\/ajt.15325","article-title":"Variation in use of procurement biopsies and its implications for discard of deceased donor kidneys recovered for transplantation","volume":"19","author":"Lentine","year":"2019","journal-title":"Am J Transplant"},{"key":"B9-20260114","doi-asserted-by":"crossref","first-page":"660","DOI":"10.1016\/j.kint.2021.04.020","article-title":"Trends and impact on cold ischemia time and clinical outcomes using virtual crossmatch for deceased donor kidney transplantation in the United States","volume":"100","author":"Puttarajappa","year":"2021","journal-title":"Kidney Int"},{"key":"B10-20260114","doi-asserted-by":"crossref","first-page":"373","DOI":"10.1016\/j.jamcollsurg.2019.12.031","article-title":"Virtual crossmatching in kidney transplantation: The wait is over","volume":"230","author":"Rohan","year":"2020","journal-title":"J Am Coll Surg"},{"key":"B11-20260114","doi-asserted-by":"crossref","first-page":"109","DOI":"10.1177\/0003134820942180","article-title":"The impact of virtual crossmatch on cold ischemic times and outcomes following kidney transplantation","volume":"87","author":"Aslam","year":"2021","journal-title":"Am Surg"},{"key":"B12-20260114","doi-asserted-by":"crossref","first-page":"422","DOI":"10.1097\/TP.0000000000000844","article-title":"Logistical factors influencing cold ischemia times in deceased donor kidney transplants","volume":"100","author":"Shrestha","year":"2016","journal-title":"Transplantation"},{"key":"B14-20260114","doi-asserted-by":"crossref","first-page":"S38","DOI":"10.1016\/j.acap.2013.08.002","article-title":"Use of interrupted time series analysis in evaluating health care quality improvements","volume":"13","author":"Penfold","year":"2013","journal-title":"Acad Pediatr"},{"key":"B15-20260114","doi-asserted-by":"crossref","first-page":"480","DOI":"10.1177\/1536867X1501500208","article-title":"Conducting interrupted time-series analysis for single- and multiple-group comparisons","volume":"15","author":"Linden","year":"2015","journal-title":"Stata J"},{"key":"B16-20260114","doi-asserted-by":"crossref","first-page":"1227","DOI":"10.2215\/CJN.03320708","article-title":"The Declaration of Istanbul on Organ Trafficking and Transplant Tourism","volume":"3","year":"2008","journal-title":"Clin J Am Soc Nephrol"},{"key":"B17-20260114","doi-asserted-by":"crossref","first-page":"2900","DOI":"10.1681\/ASN.2020030335","article-title":"Major variation across local transplant centers in probability of kidney transplant for wait-listed patients","volume":"31","author":"King","year":"2020","journal-title":"J Am Soc Nephrol"},{"key":"B18-20260114","doi-asserted-by":"crossref","first-page":"1842","DOI":"10.1681\/ASN.2013070784","article-title":"New national allocation policy for deceased donor kidneys in the United States and possible effect on patient outcomes","volume":"25","author":"Israni","year":"2014","journal-title":"J Am Soc Nephrol"},{"key":"B19-20260114","doi-asserted-by":"crossref","first-page":"1129","DOI":"10.1111\/ajt.15149","article-title":"The national landscape of deceased donor kidney transplantation for the highly sensitized: Transplant rates, waitlist mortality, and posttransplant survival under KAS","volume":"19","author":"Jackson","year":"2019","journal-title":"Am J Transplant"},{"key":"B20-20260114","doi-asserted-by":"crossref","first-page":"2101","DOI":"10.1111\/ajt.15825","article-title":"How do highly sensitized patients get kidney transplants in the United States? Trends over the last decade","volume":"20","author":"Jackson","year":"2020","journal-title":"Am J Transplant"},{"key":"B21-20260114","doi-asserted-by":"crossref","DOI":"10.2215\/CJN.01600222","article-title":"Implications of accumulated cold time for US kidney transplantation offer acceptance","author":"Barah","year":"2022","journal-title":"Clin J Am Soc Nephrol"},{"key":"B22-20260114","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1111\/ajt.16859","article-title":"Kidney accelerated placement project: Outcomes and lessons learned","volume":"22","author":"Noreen","year":"2022","journal-title":"Am J Transplant"},{"key":"B23-20260114","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1111\/ajt.16866","article-title":"Accelerating deceased donor kidney utilization requires more than accelerating placement","volume":"22","author":"Mohan","year":"2022","journal-title":"Am J Transplant"},{"key":"B24-20260114","doi-asserted-by":"crossref","first-page":"471","DOI":"10.1111\/tan.13693","article-title":"Out with the old, in with the new: Virtual versus physical crossmatching in the modern era","volume":"94","author":"Morris","year":"2019","journal-title":"HLA"},{"key":"B25-20260114","doi-asserted-by":"crossref","first-page":"659","DOI":"10.1016\/j.kint.2020.02.001","article-title":"Virtual crossmatching for deceased donor transplantation: One size does not fit all","volume":"97","author":"Pinelli","year":"2020","journal-title":"Kidney Int"},{"key":"B26-20260114","doi-asserted-by":"crossref","first-page":"378","DOI":"10.1097\/MOT.0000000000000675","article-title":"Machine perfusion in kidney transplantation","volume":"24","author":"Kataria","year":"2019","journal-title":"Curr Opin Organ Transplant"},{"key":"B27-20260114","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1016\/j.kint.2018.02.016","article-title":"Factors leading to the discard of deceased donor kidneys in the United States","volume":"94","author":"Mohan","year":"2018","journal-title":"Kidney Int"},{"key":"B28-20260114","doi-asserted-by":"crossref","first-page":"1239","DOI":"10.1111\/tri.13899","article-title":"Association between procurement biopsy findings and deceased donor kidney outcomes: A paired kidney analysis","volume":"34","author":"Husain","year":"2021","journal-title":"Transpl Int"},{"key":"B29-20260114","doi-asserted-by":"crossref","first-page":"3413","DOI":"10.1111\/ajt.15952","article-title":"Kidney nonprocurement in solid organ donors in the United States","volume":"20","author":"Yu","year":"2020","journal-title":"Am J Transplant"},{"key":"B31-20260114","doi-asserted-by":"crossref","first-page":"2463","DOI":"10.1016\/j.ekir.2021.06.002","article-title":"Deceased donor kidneys utilization and discard rates during COVID-19 pandemic in the United States","volume":"6","author":"Li","year":"2021","journal-title":"Kidney Int Rep"}],"container-title":["Journal of the American Society of Nephrology"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1681\/ASN.2022040471","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,7]],"date-time":"2026-08-07T19:47:26Z","timestamp":1786132046000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1681\/ASN.2022040471"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,27]]},"references-count":27,"journal-issue":{"issue":"1","published-print":{"date-parts":[[2023]]}},"URL":"https:\/\/doi.org\/10.1681\/asn.2022040471","relation":{},"ISSN":["1046-6673","1533-3450"],"issn-type":[{"value":"1046-6673","type":"print"},{"value":"1533-3450","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,27]]},"assertion":[{"value":"2022-04-21","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2022-08-16","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}