ArticleJournal of the American Society of Nephrology : JASN2023
Early Effect of the Circular Model of Kidney Allocation in the United States.
Article in Journal of the American Society of Nephrology : JASN, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 23 papers.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
23 citing papers in PubMed, 47 citations in OpenAlex.
- A Sliding Scale AdaptiVe Expedited rescue algorithm for deceased donor kidney transplantation.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2026Article
- Newly Designed Expedited Allocation Pathways Cannot Be Expected to Rely on Data That Do Not Currently Exist.Kidney360 · 2026Article
- Expedited Transplant Allocation Using a Paired Kidney Cohort.JAMA network open · 2026Article
- Out-of-Sequence Placement of Deceased Donor Kidneys Is Exacerbating Inequities in the United States.Clinical journal of the American Society of Nephrology : CJASN · 2026Article
- The Evolving Kidney Donor Pool Shaping Outcomes in Graft Survival.Journal of transplantation · 2026Article
- A Comprehensive Analysis on the Impact of Hypothermic Machine Perfusion and its Influence on Delayed Graft Function.Transplantation direct · 2025Article
- Acceptance of High Kidney Donor Profile Index Kidneys Among Consented Candidates.Kidney international reports · 2025Article
- Decreasing efficiency in deceased donor kidney offer notifications under the new distance-based kidney allocation system.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2025Article
- Mosaic Loss of Y Chromosome Defines a Proximal Tubular Cell State Associated with Recovery from DGF and of Allograft Quality and Functional Reserve Post DCD Kidney Transplantation.Annals of surgery · 2025Article
- Adopting orphan deceased donor kidneys for transplantation.BMC nephrology · 2025Article
- Chronic Allograft Nephropathy-A Narrative Review of Its Pathogenesis, Diagnosis, and Evolving Management Strategies.Biomedicines · 2025Review
- Optimizing kidney allocation: challenges and solutions.Current opinion in organ transplantation · 2025Review
- Equity and the operational considerations of the kidney transplant allocation system.Current opinion in organ transplantation · 2025Review
- Outcomes for Patients With a Deceased Donor Kidney Offer in the New Allocation System.Kidney international reports · 2025Article
- Diagnosing the Recent Decrease in Utilization of Deceased Donor Kidneys.Transplantation · 2025Article
- Associations Among Circle-Based Kidney Allocation, Center Waiting Time, and Likelihood of Deceased-Donor Kidney Transplantation.American journal of kidney diseases : the official journal of the National Kidney Foundation · 2025Article
- Variation Across Organ Procurement Organizations in Deceased-Donor Kidney Offer Notification Practices.Clinical transplantation · 2024Article
- A Transplant-Inclusive Value-Based Kidney Care Payment Model.Kidney international reports · 2024Review
- Optimizing the kidney donor pool: transplanting donor kidneys after partial nephrectomy of masses or cysts.Frontiers in surgery · 2024Article
- Deceased donor kidneys from higher distressed communities are significantly less likely to be utilized for transplantation.American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons · 2023Article
Corrections and comments
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Authors and funding
9 authors at 3 institutions in 1 country.
Funding
Abstract
backgroundIn 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.
methodsWe 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.
resultsPost-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%-98% (12% versus 8%; P <0.001) and those with >5 years of pretransplant dialysis (35% versus 33%; P <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.
conclusionsEarly 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.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.