Changes to waiting time criteria for kidney pancreas candidates
Sponsoring Committee: Pancreas Transplantation
Strategic Goal: Increase the number of transplants
Policy notice (PDF - 32 K; 7/2018)
Board briefing paper (PDF - 629 K; 6/2018)
A section of the kidney pancreas (KP) waiting time criteria limits waiting time accrual to candidates on insulin that have either a C-peptide ≤ 2 ng/mL or a C-peptide 2 > ng/mL and a body mass index (BMI) below or equal to the maximum (30 kg/m2). Pancreas Committee (Committee) analysis and review of current evidence indicates that this waiting time criterion represents an unnecessary and arbitrary limitation to certain candidates’ ability to accrue waiting time. Because waiting time is an important part of pancreas allocation, it may also limit these candidates’ access to transplantation.
The waiting time criterion was included in the 2014 Pancreas Allocation System (PAS) because of concerns about outcomes for high BMI Type 2 candidates (who are identified by having a high Cpeptide). However, evidence gathered by the Committee suggests this restriction for Type 2 candidates is arbitrary because Type 1 and Type 2 KP recipients may have comparable outcomes. Additionally, well-selected Type 2 high BMI simultaneous pancreas-kidney (SPK) recipients may have comparable outcomes to other SPK recipients. The KP waiting time criterion arbitrarily restricts waiting time for Type 2 high BMI candidates while allowing Type 1 high BMI candidates to accrue waiting time and have greater access to transplant. Asians, African Americans and comprise a higher proportion of Type 2 candidates and recipients with a high BMI (> 30), indicating that the current policy may create an inequity in restricting minority KP candidate access to waiting time accrual.
Changing KP waiting time criteria aligns with the first OPTN strategic goal to increase the number of transplants. In 2015, 25% of pancreata recovered for transplant were discarded. By enhancing access for candidates currently prevented from accruing waiting time, this proposal may reduce the pancreas discard rate and increase the total number of KP transplants. By removing a barrier to waiting time accrual for minority populations, this proposal may also reduce an inequity in access to transplant in alignment with the OPTN second strategic goal. Ultimately, removing the KP waiting time criterion and maximum allowable BMI would provide certain candidates access to kidney and pancreas transplantation based on center best practices and clinical evidence rather than an arbitrary waiting time criterion.
Read the full proposal (PDF; 1/2018)
Members are asked to comment on both the immediate and long term budgetary impact of resources that may be required if this proposal is approved. This information assists the Board in considering the proposal and its impact on the community.