Survival and quality of life impact of a risk-based allocation algorithm for deceased donor kidney transplantation

To determine the incremental gains in graft and patient survival under a risk-based, deceased donor kidney allocation compared to the current Australian algorithm.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 quality-adjusted life years and graft years between the 8 risk-based allocation strategies against current practice.Compared to current practice, KDRI-EPTS matching of the lowest 20% of scores reduced median waiting time by 0.64 years (95% CI: 0.52-0.73) for recipients aged ≤ 30 years, but increased waiting time by 0.94 years (95% CI: 0.79 - 1.09) for recipients aged > 60 years. Among all age groups, the greatest gains occurred if KDRI-EPTS 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 to 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. Prioritisation of lower quality donor kidneys for older candidates reduced the waiting time for recipients aged > 45 years, but no changes in graft and patient survivals were observed.Risk-based matching engendered a moderate, overall increase in graft and patient survival, accrued through benefits for recipients aged ≤ 45 years but disadvantage to recipients aged > 60 years