1 OPTN Update Brian Shepard Chief Executive Officer UNOS November 17, 2015.

1

OPTN Update

Brian Shepard

Chief Executive Officer

UNOS

November 17, 2015

2

Strategic Alignment

3

2012 v. 2015 Goals

4

Feedback from Regional Surveys

Increase the number of trans-

plants

Increase access to transplants

Improve survival for patients with end

stage organ failure

Promote transplant patient safety

Promote living donor safety

Promote the effi-cient management

of the OPTN

0

100

200

300

400

500

600

5

Re-Balancing Resource Allocation

2015-2016 allocation of effort:Increase transplants 40%Provide equity

30%Improve outcomes 15%Promote safety

10%Promote efficiency 5%

2014 Committee Projects

more txs access survival pt safety efficiency

7

2015 Committee Project Portfolio

1 2 3 4 5 60%

5%

10%

15%

20%

25%

30%

35%

40%

45% Current ExCom BenchmarkBoard Benchmark

The New Kidney Allocation System (KAS): The First Six Months

Background KAS implemented Dec 4, 2014

Key goals: Make better use of available kidneys

Increase transplant opportunities for difficult-to-match patients (increased equity)

Increase fairness by awarding waiting time points based on dialysis start date

Have minimal impact on most candidates

KAS: The First Six Months

Background (cont.) Performance tracked monthly through June (“out of the gate” reports)

Comprehensive, 6-month analysis requested by the kidney committee Pre-KAS period: June 1, 2013 – December 3, 2014 (18 months) Post-KAS period: December 4, 2014 – May 31, 2015 (6 months)

(http://optn.transplant.hrsa.gov)


http://optn.transplant.hrsa.gov/



Solitary deceased donor transplants under KASPre vs. post-KAS trends

Over time (per 30 days)

Jul-13 Nov-13 Feb-14 May-14 Sep-14 Dec-14 Mar-15 Jul-150

500

1000899

851.6 838.9

938965.5

841.1

929 926.1

Num

ber

of tr

ansp

lant

s pe

r 30

-day

per

iod

KAS

impl

emen

tatio

n

On average

Pre-KAS (6/1/13-12/3/14) Post-KAS (12/4/14-5/31/15)0

500

1000893.2 903.0

Num

ber

of tr

ansp

lant

s pe

r 30

-day

per

iod 1%↑

(Total N=16,406) (Total N=5,388)

Transplant volume has increased slightly (about 1%) post-KAS.KAS: The First Six Months Table II.1a

Who’s getting transplanted under KAS? (1/1)Percentage of Deceased Donor Kidney Transplants by Recipient Age

0-17 18-34 35-49 50-64 65+0%

25%

50%

0.9%

9.6%

25.5%

43.0%

20.9%

4.3%

8.9%

23.8%

40.9%

22.2%

3.6%

13.5%

28.5%

37.4%

17.0%

Waitlist (11/30/2014)Pre-KASPost-KAS

Recipient age KAS: The First Six Months

More young adults (18-49) are receiving kidney transplants.

Still, over half of transplants are going to age 50+ recipients under KAS.Eras - Pre: 18 months (June 1, 2013 – Dec 3, 2014) Post: 6 months (Dec 4, 2014 – May 31, 2015)

Table 1.2aTable II.1b

Who’s getting transplanted under KAS? (2/2)Percentage of Deceased Donor Kidney Transplants by Recipient CPRA

0 1-79 80-94 95-98 99-1000%

25%

50%

75%

61.8%

22.5%

4.2% 3.1%

8.3%

60.2%

23.9%

10.0%

3.5% 2.3%

55.3%

21.2%

4.9% 3.8%

14.8%


Recipient CPRA

Transplants have increased sharply for CPRA 99-100% patients.

Transplants have declined for CPRA=0% and 80-94% patients.KAS: The First Six Months


CPRA 99-100% recipient “bolus effect”

0%

10%

20%

2.4%1.4%1.6%1.8%

3.3%

2.0%1.8%1.6%

3.2%2.3%2.0%

2.9%1.8%

3.5%2.9%2.5%2.8%

2.4%

17.7%

15.7%15.6%

13.4%

14.6%

12.6%

Transplant date

% o

f tra

nspl

ants

to C

PRA

99-

100%

reci

pien

ts

KAS

impl

emen

tatio

n

Transplants to CPRA 99-100% patients rose sharply after KAS but have been tapering over time, likely due to a bolus effect. KAS: The First Six Months

Table A.1d

Who’s getting transplanted under KAS? (3/4)Percentage of Deceased Donor Kidney Transplants by Recipient Duration on Dialysis

Preemptive 0-1 1-5 5-10 10+0%

25%

50%

75%

14.9%

9.1%

49.5%

21.3%

5.2%8.8%

11.0%

50.0%

26.1%

4.2%5.1% 6.9%

39.4%35.5%

13.2%


Recipient duration on dialysis (years)

More transplants are going to long dialysis duration recipients.

Fewer preemptive (before dialysis) transplants.KAS: The First Six Months Table 1.2a

Table II.1b

Who’s getting transplanted under KAS? (4/4)Percentage of Deceased Donor Kidney Transplants by Recipient Race/ethnicity

AFRICAN AMERICAN CAUCASIAN ASIAN HISPANIC MULTIRACIAL NATIVE_AMERICAN NATIVE_ISLANDER0%

25%

50%

34.3%36.5%

7.9%

19.2%

0.6% 1.1% 0.5%

31.5%

42.4%

7.1%

16.9%

0.6%1.1%

0.5%

37.9%

34.2%

6.8%

18.4%

0.6% 1.5% 0.6%

Waitlist (11/30/2014) Pre-KAS

Post-KAS

Recipient race/ethnicity

More African Americans are receiving kidney transplants under KAS.

Transplants have also increased for Hispanics, but declined for Whites.KAS: The First Six Months


Longevity-matching under KASPercentage of Deceased Donor Kidney Transplants by KDPI and Recipient Age

KDPI 0-20 KDPI 21-34 KDPI 35-85 KDPI 86-100 KDPI 0-20 KDPI 21-34 KDPI 35-85 KDPI 86-100

% % % % % % % % % %

0-17 2.9 0.8 0.6 0.0 4.3 0-17 2.5 0.9 0.2 0.0 3.6

18-34 2.5 1.9 4.4 0.1 8.9 18-34 6.7 2.4 4.3 0.1 13.5

35-49 5.5 4.5 13.2 0.6 23.8 35-49 7.3 4.7 15.9 0.6 28.5

50-64 7.1 6.5 23.6 3.7 40.9 50-64 2.8 6.0 25.4 3.3 37.4

65 Plus 2.9 2.6 13.1 3.6 22.2 65 Plus 1.0 2.2 10.9 3.0 17.0

All 20.9 16.2 54.8 8.1 100.0 All 20.3 16.2 56.5 7.0 100.0

POST-KAS (12/4/2014-5/31/2015)

AGE

KDPIAll

PRE-KAS (6/1/2013-12/3/2014)

AGE

KDPIAll

Transplants with KDPI 0-20% and recipient age 18-34: Pre-KAS: 2.5% of transplants / Post-KAS: 6.7% of transplants

Transplants with KDPI 0-20% and recipient age 50+: Pre-KAS: 10% of transplants / Post-KAS: 4% of transplants

KAS: The First Six Months Table II.3b

Geographic distribution of kidney transplants

78.8%

8.7%

12.5%Pre-KAS

Local Regional National

21.2%

67.8%

12.8%

19.5%

Post-KAS

Local Regional National

32.3%

More kidneys are being distributed outside recovery OPO’s DSA.KAS: The First Six Months Table II.1b

Geographic distribution of kidney transplants (cont)

1 2 3 4 5 6 7 8 9 10 110%

25%

3.9%

12.5%13.3%

9.3%

17.1%

4.5%

7.1% 7.2%6.1%

7.9%

11.2%

3.5%

12.6%

14.0%

9.8%

18.0%

3.9%

6.6% 6.8%6.2%

7.7%

10.9%

Pre-KAS Post-KAS

OPTN Region

No significant changes by OPTN region.

KAS: The First Six Months Table II.6

Cold ischemic times for transplanted kidneys

0-4 4-8 8-12 12-16 16-20 20-24 24-36 >=360%

25%

1.6%

11.3%

18.2%19.7%

17.7%

13.2%

14.7%

3.6%

1.9%

9.7%

15.4%

18.6%17.5%

14.0%

18.8%

4.1%

Pre-KAS Post-KAS

CIT (hours)

Average CIT increased 6% from 17.0 to 18.1 hours CIT> 24 hours - Pre-KAS: 18.3%, Post-KAS: 22.9%


Table II.1d (known CIT only)

Delayed graft function (DGF) rates

Pre-KAS Post-KAS0

10

20

30

40

24.5

30.8

% d

elay

ed g

raft

func

tion

The percentage of recipients requiring dialysis within the first week after transplant increased from 24.5% pre-KAS to 30.8% after KAS.

KAS: The First Six Months Table II.16

Kidney recovery & utilization under KASPercentage of Recovered Deceased Kidney Donors by KDPI

0-20 21-34 35-85 86-1000%

20%

40%

60%

19.4%

14.4%

51.7%

14.5%

18.8%

14.0%

53.0%

14.1%

Pre-KAS Post-KAS

KDPI

Total kidney donors recovered per month increased 4% (636 to 661).

However, the distribution by KDPI has remained very similar.KAS: The First Six Months Table III.1b

Kidney recovery & utilization under KAS (cont)Kidney Discard Rate by KDPI -- including months 7-10 (Jun – Sep ‘15)

0-20 21-34 35-85 86-100 Overall0%

25%

50%

75%

2.3%6.2%

17.4%

55.6%

18.5%

2.0%7.3%

19.2%

61.9%

20.2%

2.7%6.6%

18.4%

56.0%

18.4%

Pre-KASPost-KAS (mos. 1-6)Post-KAS (mos. 7-10)

Discard rates

Discard rates have returned to pre-KAS levels in recent months. KAS: The First Six Months

Summary: First Six Months of KAS Overall – KAS is meeting key goals

Highly successful 6-month pre-KAS preparation period

Decrease in longevity mismatches

Increase in the number of transplants among very highly sensitized patients

Increase in access to transplant for African Americans candidates

“Bolus effects”: the percent of transplants to CPRA 99-100% and dialysis>10 years recipients are both tapering post-KAS

Increase in A2/A2BB transplants, but still room for growth

Transplant volume up 1%


Summary: First Six Months of KAS (cont’d) Several trends deserve further attention:

Fewer 0MM transplants

Slight drop in pediatric transplants will continue to be tracked closely

Logistical challenges in allocation

Increased CIT and DGF

Increase in discard rates, particularly KDPI>85% kidneys. Rates appear to be returning back to pre-KAS levels based on months 7-10.

Other metrics (e.g., graft survival rates) require additional lag time and will be available in future reports


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Latest VCA Data

27

Approved VCA Transplant Programs* as of 10/23/2015

VCA Type N

Upper Limb 17Head and Neck 13Abdominal Wall 12Other Specify: Uterine 3Other Specify: Penile 2Other Specify: Genitourinary 1Other Specify: Lower Limb 1Other Specify: Urogenital 1Other Specify: Genitourinary (Excluding Lines) 1Total* 51

* Represents 23 unique transplant centers

28

Geographic Locations of Approved VCA Transplant Centers as of 10/23/2015

• Centers with at least one VCA registration currently waiting• Centers with no VCA registrations currently waiting

29

VCA Waiting List and Transplant Numbers as of 10/23/2015 by Type

VCA TypeNumber of Candidates

Added to the Waiting List, 7/3/2014-10/23/2015

Number of Transplants,

7/3/2014-10/23/2015

Number of Candidates

Waiting as of 10/23/2015

Abdominal Wall 3 1 -

Head and Neck: Craniofacial 3 3 -

Head and Neck: Scalp 1 1 -

Upper Limb, Bilateral 9 2 6

Upper Limb, Unilateral 4 2 2

Total 20 9 8

30

Other Organs Recovered from 8 VCA Donors, 7/3/2014-10/23/2015

Non-VCA Organ N

Heart 6

Intestine 2

Kidney 13

Kidney-Pancreas 1

Liver 8

Lung 4

Pancreas 1

Total 35

Demographics of VCA Donors, 7/3/2014-10/23/2015

N %

Age 0-17 2 25.0

18-34 4 50.0

35-44 2 25.0

Gender Male 8 100.0

Ethnicity White 6 75.0

Black 1 12.5

Hispanic 1 12.5

Redesigning Liver Distribution

32

Redesigning Liver Distribution (cont.)

The Committee unanimously resolved to

consider additional results in modeling of concepts

previously developed and to further analyze an additional concept…

Board Resolution

Concept presented to Committee

Statement to the Community

Development of Steering Committee

Concept Paper &

Questionnaire

September 2014 Liver

Forum

Development of the Ad Hoc

Subcommittees

Additional Modeling

and Analyses

June 2015 Forum

Additional Modeling

and Analyses

33

Metrics and quality improvement

• MPSC Outcomes workgroup• OPO metrics• Member Quality pilot• Real life lessons

34

Acknowledgements

Darren Stewart

John Beck

Anna Kucheryavaya

Wida Cherikh

James Alcorn

Christine Flavin

35

OPTN Update

Brian Shepard

Chief Executive Officer

UNOS

November 17, 2015

1 OPTN Update Brian Shepard Chief Executive Officer UNOS November 17, 2015.

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Transcript of 1 OPTN Update Brian Shepard Chief Executive Officer UNOS November 17, 2015.