Background: The new Kidney Allocation System (KAS) implemented on 12/4/14 included an increased allocation priority for candidates with CPRA 99-100%. On 11/30/14, just days prior to KAS, 8,209 (8.1%) of all kidney candidates had CPRA 99-100%.

Data and Methods: We performed logistic regression to determine which patient factors were independently associated with CPRA 99-100% (vs. 0-98%) for kidney candidates on the waiting list on 11/30/14. Continuous factors were fit using restricted cubic splines to allow for the greatest flexibility in model fit. All results were based on OPTN data supplemented with CMS dialysis data.

Results: Prior transplants, from one (Odd Ratio (OR) = 13.7) or multiple donors (OR=21.5 for 2 and 21.4 for 3+ donors), had the most influence on the likelihood of patient being very highly sensitized. The following patient characteristics also independently increased the odds of having CPRA 99-100%: female (OR=3.1), multiply listed (1.9), blood types A and AB (1.3, 1.4), African American race/ethnicity (1.3), longer time on the waiting list and dialysis, and recipient age. Inactive status on the list (0.5), candidate not being on dialysis (0.5), diabetes (0.9) and Hispanic race/ethnicity (0.9) were associated with decreased odds (Figures 1 and 2).

The model had excellent predictive ability (C-statistic = 0.884).

Conclusions: Prior transplant was by far the most influential independent factor greatly increasing odds of a waiting list patient being reported as very highly sensitized. Gender, inactive status, and preemptive listing were also highly significant. This analysis helps explain which patient groups are more likely to receive increased access to transplants under KAS.

CITATION INFORMATION: Kucheryavaya A, Klassen D, Stewart D. Characteristics Independently Associated with Kidney Candidates Having CPRA of 99-100%. Am J Transplant. 2016;16 (suppl 3).

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