Should the Current Zero HLA ABDR-Mismatch Priority in Kidney Allocation System Continue?

KEY POINTS: Zero HLA ABDR mismatch priority in the Kidney Allocation System is highly biased against minority candidates. Zero HLA ABDR mismatch priority shunts 2.5% of O donors to nonidentical blood types disadvantaging O recipients. Zero HLA ABDR-mismatch priority recipients have substantially shorter dialysis exposure before transplant than nonpriority recipients. BACKGROUND: In the Kidney Allocation System (KAS), adult kidney candidates who are a zero HLA ABDR-mismatch with a potential donor are given priority in the match run over nonzero HLA ABDR-mismatch candidates. Furthermore, KAS allows for the shunting of kidneys to zero-mismatch candidates across compatible ABO blood types, potentially disadvantaging O candidates who have longer waiting times. This study was undertaken to determine who is receiving zero HLA ABDR-mismatch kidneys, the number of donors shunted to nonidentical ABO recipients, the effect on dialysis exposure before transplant, and the current patient and graft outcomes. METHODS: All adult deceased donor kidney recipients since the start of KAS on December 4, 2014, were included in the study. Multiorgan transplants with a kidney, 98%-100% calculated panel reactive antibodies (CPRAs), previous living donors, pediatric, medically urgent, and safety net transplants were excluded. Patients were considered a zero-mismatch allocation if they received a zero HLA ABDR-mismatch kidney and had an allocation CPRA