The following is the summary of “Referral and Evaluation for Kidney Transplantation Following Implementation of the 2014 National Kidney Allocation System” published in the December 2022 issue of Kidney diseases by Patzer, et al. 

The United States’ waiting period officially begins when a patient is diagnosed with kidney failure rather than when they are placed on the waitlist. This change was made as part of the national kidney allocation system (KAS) that went into effect in December 2014. While waitlisting has decreased in the wake of KAS, the reasons for this fall remain unclear. They may be attributable to shifts in transplant center policies or modifications in how dialysis facilities refer and evaluate patients. The goal of this research was to determine if the 2014 KAS policy shift had an effect on the number of newly diagnosed and previously diagnosed kidney failure patients who were referred for transplant evaluation.

Methodology Cohort study about 37,676 incident patients from 2012-2016 was found in the US Renal Data System at 9 transplant facilities in Georgia, North Carolina, and South Carolina and were followed through December 2017. About 6,079 people were on maintenance dialysis in 2012 but were not referred for transplantation at any of the same centers where they were treated. KAS era exposure (pre-KAS vs post-KAS). The outcome is the patient being referred for transplant examination and waiting. Cox proportional hazards models with several covariates and time-dependent outcomes for the incident and persistent population. Overall waitlisting was reduced (adjusted HR, 0.70 [95% CI, 0.65-0.76]), and active waitlisting among those assessed was lower (adjusted HR, 0.81 [95% CI, 0.74-0.90]) among incident patients compared to the pre-KAS era. In the general population, KAS was linked to more people being placed on a waiting list (adjusted HR, 1.74 [95% CI, 1.15-2.63]) and more people being placed on an active waiting list after an evaluation (adjusted HR, 2.01 [95% CI, 1.16-3.49]), but it did not have any appreciable effect on referral or evaluation start rates.

Only 3 states alone, yet there was still residual confusion. KAS had varying effects on the transplantation process for incident and prevalent patients with renal failure in the southeastern United States. After KAS was implemented, there was an increase in referrals from dialysis facilities and evaluations of incident patients from transplant centers, but there was a decrease in waitlist placements for patients who had been evaluated. It’s possible that the observed shifts in access to transplantation were impacted by shifts in conduct on the part of dialysis facilities and transplant centers following the adoption of KAS.