Kidney transplantation (KT) is curative for end-stage renal disease and is the most frequently performed transplant procedure (>21,000/annually). Despite 2018 being a record year for donation, deceased donor organ supply remains well short of the >94,000 patients active on the KT waitlist. For anesthesiologists caring for KT recipients, the landscape is rapidly changing with respect to allocation policies and perioperative care strategies. The more significant changes are briefly summarized below.

To reduce disparity and improve utilization of deceased donor (DD) kidneys, the Organ Procurement and Transplantation Network (OPTN) introduced the new Kidney Allocation System (KAS) in 2014. Anesthesiologists caring for KT recipients should be aware of adjustments of KT priority and implications for perioperative care.

KAS is founded upon integration of the kidney donor profile index (KDPI) and estimated post-transplant survival (EPTS). KDPI estimates the probability of graft failure from 0-100 percent based upon 10 donor factors....

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