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In 2022, we did fewer than 20,000 kidney transplants and discarded thousands more…. and it took nearly 30 million offers. Kidneys that reached patients were turned down twice as often compared to 2 years prior. #broken #kidney #allocation

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Another way to think about this… how often does a kidney actually go to the person at the top of the allocation match run … well… not very often, it turns out

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How inefficient is the new kidney allocation system in the US? the number of offers increased so rapidly that some centers were receiving > 100,000 offers per year. Is it any surprise that no one is paying close attention anymore? www.kireports.org/article/S246...

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Sumit Mohan @sumitmohan.bsky.social · 03/01/2025

And yet folks continue to defend the status quo… our allocation system is broken and those responsible for regulation are asleep at the wheel…

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Happens in any 24 hr urine collection with a UTI or bacteriuria. The urea clearance is much higher than the creatinine clearance rather it being the other way around…. leads to a falsely low CrCl that gets incorrectly blamed on an incomplete collection.

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Sumit Mohan @sumitmohan.bsky.social · 19/12/2024

Given the challenges around organ utilization and discards, figuring out reliable estimates of organ quality are a big piece of the puzzle if we are going to make real improvements and increase access to transplant.

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Reposted by Sumit Mohan

kireports.bsky.social @kireports.bsky.social · 12/12/2024

Outcomes of #Living Kidney #Donors Following Donor #Nephrectomy in Aotearoa New Zealand #VisualAbstract by @krishnadoctor1 www.kireports.org/ar...

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Sumit Mohan @sumitmohan.bsky.social · 09/12/2024

This has been an inspiring conference so far with so many patient voices and the broad engagement of so many professionals

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Reposted by Sumit Mohan

jradnephro.bsky.social @jradnephro.bsky.social · 04/12/2024

NEXT WEEK: Join us for ‘#ClinicalGenetics in #KidneyTransplantation’ - a virtual conference on Friday, December 13, 2024 – 7.25 ACCME Credits. www.eventleaf.com/e/ClinicalGe... #Genomics #Genetics #MedicalGenetics #Kidney #Nephrology #NephPearls #CKD

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Reposted by Sumit Mohan

Altmetric @altmetric.com · 04/12/2024

Legend:

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Reposted by Sumit Mohan

Altmetric @altmetric.com · 04/12/2024

The Rise of Skywalkers

Altmetric cumulative attention shown by day in the Altmetric Explorers. The Sky Blue section from Bluesky is growing over time.

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Sumit Mohan @sumitmohan.bsky.social · 28/11/2024

For many the low hanging fruit is expanding their living donor program

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Sumit Mohan @sumitmohan.bsky.social · 28/11/2024

The secret sauce here is going to good waitlist management - eliminate internal holds, inactivate folks that aren’t ready, implement filters well. This coupled with review of offers that are declined but accepted by others.

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There should be a few papers coming … if we can make it past the reviewers 😂 … it’s been more of a challenge than usual

Perhaps the biggest challenge with #IOTA is continued inclusion of out-of-sequence (OOS) deceased donor kidneys in center volume. This means that centers that are randomized are essentially incentivized to increase OOS placements to meet volume goals and inflate their organ offer acceptance rates

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public-inspection.federalregister.gov

The full 595 pages of the #IOTA rule - public-inspection.federalregister.gov/2024-27841.pdf is excellent bedtime reading but the easier to read model website is at www.cms.gov/priorities/i...

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#IOTA a MAJOR win for patients. Centers need to grow if we want to improve access to the best treatment option for ESRD and lower the discard rate in a more efficient system that holds centers accountable for their organ and patient selection choices

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Improved information about waitlisting practices is a good first step on the transparency front and will likely benefit from the new pre-waitlisting data requirements from HRSA that are out for public comment now from OMB. #IOTA

But a center that excels at organ offer acceptance and period prevalence graft outcomes will get the max incentive with slightly slower growth too. Unfortunately, the graft survival metric is unadjusted.

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The growth targets are lower and thus more likely to be attainable with the max points going to centers that meet 125% of their target which is baseline plus the national growth rate. Thats still quite high @ 31% growth if the national growth rate is 5%.

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Randomization occurred at the DSA level which is an odd choice given that this is no longer part of allocation - and equity measures were removed as and the equity plan is now voluntary only.

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Transparency took a hit when the sharing of organ offers that was in the proposed rule was taken away. This was disappointing to see but met stiff resistance from ASTS and the AHA. #IOTA

More seriously, it recognizes that part of the problem impeding access to transplants is allocation efficiency and call attention to the organ offer acceptance rates while also encouraging centers to grow their living donor programs #IOTA

#IOTA incentives transplant centers to grow volume with a $15K incentive per medicare patient transplanted if you hit their goals on volume, efficiency and quality. Its a well thought idea - mostly because they cite us > 40 times 😂

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The final rule for CMMI's Increasing Organ Transplant Access (IOTA) from CMMI dropped yesterday - and is the first time that CMS is actively encouraging transplant programs to grow. Its only 595 pages but to see if your center was randomized to participate look here - www.cms.gov/files/docume...

cms.gov