Pancreas Transplantation Committee In order to accrue waiting time KP candidates must be O n insulin and have a Cpeptide 2 ngmL OR O n insulin have a Cpeptide gt 2 ngmL and a body mass index BMI below the maximum currently 30 kgm ID: 913257
Download Presentation The PPT/PDF document "1 Proposal to Change Waiting Time Criter..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
1
Proposal to Change Waiting Time Criteria for Kidney-Pancreas Candidates
Pancreas Transplantation Committee
Slide2In order to accrue waiting time, KP candidates must be:
On insulin and have a C-peptide ≤ 2 ng/mL
OR
On insulin, have a C-peptide > 2 ng/mL and a body mass index (BMI) below the maximum (currently 30 kg/m2) Waiting time accrual is important to SPK candidates because it impacts allocation
Background
2
Slide3Max BMI
calculated every 6 mos., based on % active KP candidates
that meet criterion
3.b (on insulin, C-peptide > 2, BMI ≤ maximum). Max BMI cannot exceed 30 kg/m2Background
3
Slide44
What problems will the proposal solve?
C
riterion restricts waiting time accrual for Type 2 high BMI candidates without a medical basis
W
ell-selected high BMI Type 2 recipients may have comparable outcomes to other SPK recipients
P
olicy is unfair in allowing Type 1, but not Type 2 candidates with high BMIs to accrue waiting time
Slide5Recipient Survival by BMI
5
Slide6Graft Survival by BMI
6
Slide77
What problems will the proposal solve?
No need for criterion limiting T2 transplants; very
few Type 2 SPK patients are transplanted with a higher BMI
OPTN/UNOS analysis of a
2006-2016
cohort showed no trends in increasing Type 2 KP recipients and registrations
From 2004-2014 (before any restriction on waiting time accrual), there were on average < 9 Type 2 recipients with BMI ≥ 30 per year
nationally
Slide8Registrations/recipients by year, DM type
8
Slide9Otherwise acceptable transplant candidates
denied
opportunity to accrue waiting time
Asian, African American and Hispanic populations are disproportionately impacted by the criterion because they represent a greater proportion of high BMI Type 2 SPK candidates and recipients
What problems will the proposal solve?
9
Slide10Minority SPK Candidates
10
Slide11Remove the BMI/insulin requirement from KP waiting time
criteria (highlighted portion below) and references to max BMI
Proposed Solution:
11
Slide12Allows discretion of transplant
teamPrograms are already reviewed for outcomes – don’t need additional
restriction
Encourages KP transplantation and utilization of pancreataRemoves burden of reviewing maximum every six months
Reviewing max BMI every 6 months generates confusion in community
Other reasons to choose this solution?
12
Slide13Transplant hospitals need to educate staff on the policy change
Staff need to be aware of changes to KP waiting time criteria, as this will affect their procedures regarding candidate recruitment
How will
m
embers implement this
p
roposal?
13
Slide14Anticipated Board Review date: June, 2018
Programming in UNetSMModifications to managing kidney-pancreas registrations in
Waitlist
SMWaiting time that would have been accrued will be granted to candidates newly eligible for KP waiting timeSite surveys would no longer review insulin, C-peptide and BMI criteria for KP candidatesPost-implementation, committee will evaluate: Trends in Type 1 and Type 2 KP candidates/recipients
Post-transplant outcomes for patient, pancreas graft, kidney graft survival stratified by diabetes type, BMI and ethnicity
How will the OPTN implement this proposal?
14
Slide15Jon
Odorico
, MD
Pancreas Transplantation Committee Chair
jon@surgery.wisc.edu
Abigail Fox, MPA
Pancreas Transplantation Committee
Liaison
Abigail.fox@unos.org
Questions?
15
Slide16Extra Slides
16
Slide17Change the cap to a number – e.g., 32 or 36 …
PROS: would captures most of the candidates being transplanted but keeps a cap in placeCONS
: Number still arbitrary and removes discretion from transplant
teamRemove BMI cap but keep table that allows only up to 15% T2PROS: imposes limit without specifying capCONS: May result in no change to maximum allowable BMI if T2 is close to 10%, meaning BMI would stay at 30 Still an artificial limitation that removes discretion and limits access to transplantRequires continual reassessment and updating policy to reflect the correct level
Alternative Solutions Considered
17
Slide18Compared SPK candidates/recipients who met KP waiting time criteria
with those who didn’t meet criteria for:Waitlist mortality Recipients for Post-transplant
outcomes
Compared T1, T2 SPK candidates/recipients for:Waitlist mortality Post-transplant outcomes
UNOS Research Analysis:
18
Slide19Populations impacted by proposal
19
Slide20Populations impacted by proposal
20
Slide21Slide22Slide23Rarely, some KP candidates are insulin-free
However, evidence suggests they can still benefitTypically these candidates were on insulin but had to come off it while waiting for a kidney transplantOnce they get a kidney transplant, they’ll need insulin again
Therefore, an SPK or PAK transplant may be the appropriate option
The Committee supported removing this aspect of the KP waiting time criteriaInsulin Usage
23