Kidney Transplant Outcomes in Patients with CPRA Values > 98% after Implementation of the New OPTN/UNOS Kidney Allocation System (KAS): A Single Center Study Update
1Department of Medicine, Renal-Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia
2Pathology and Laboratory Medicine, Hospital of the University of Pennsylvania, Philadelphia
3Surgery, Hospital of the University of Pennsylvania, Philadelphia.
Meeting: 2018 American Transplant Congress
Abstract number: B111
Keywords: Allocation, Highly-sensitized, Kidney transplantation, Rejection
Session Information
Session Name: Poster Session B: Kidney Deceased Donor Allocation
Session Type: Poster Session
Date: Sunday, June 3, 2018
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Hall 4EF
Background: Sensitized patients in the past have had prolonged waiting times and greater incidence of death while on the waiting list. On December 4, 2014, UNOS/OPTN activated a new KAS for deceased donor (DD) kidneys that gives priority at the regional level to candidates with calculated panel reactive antibody (CPRA) value = 99% and at the national level to patients with CPRA = 100%. Transplants performed at our center under the new KAS were reviewed to assess outcomes.
Methods: Single center, retrospective data review of patients with CPRA values >98% transplanted between December 4, 2014 and May 18, 2017.
Results: We performed 397 DD kidney transplants since the new KAS and 43 patients with CPRA values >98% were transplanted. Patient characteristics are detailed in Table 1. Median KDPI for these patients was 32%. Ninety-one percent of patients had functioning grafts at median follow-up of 773 days; 6 patients (14%) had de novo DSA to an HLA class I specificity, and 4 patients (9.3%) developed de novo DSA to an HLA class II specificity. Two patients had biopsy-proven antibody mediated rejection, one of which resulted in graft loss. BK viremia occurred in 18.6% of the patients and 39.5% patients required a change in their immunosuppression, primarily decrease or withdrawal of antimetabolite agent due to BK and neutropenia.
Conclusion: Since the new KAS, highly sensitized patients received 10.8 % of the DD Kidney transplants at our center; transplanted patients have excellent short term outcomes with few rejection episodes. BK viremia is a significant concern in this population, possibly due to intense immunosuppression. Long-term follow-up is needed to better evaluate the impact of this new KAS on patient and graft outcomes.
| Gener F/M | 29/43 |
| Recipient mean age (years) | 48 |
| History of pregnancies | 23/29 (79.3%) |
| Blood transfusion prior to transplant | 25/43 (58.1%) |
| Recipient with prior transplants | 24/43 (55.8%) |
| Indution therapy | Thymoglobulin + steroids |
| Maintenance therapy | Tacrolimus + mycophenolic acid + prednisone |
CITATION INFORMATION: Kaur N., Kamoun M., Kearns J., Trofe-Clark J., Abt P., Levine M., Goral S. Kidney Transplant Outcomes in Patients with CPRA Values > 98% after Implementation of the New OPTN/UNOS Kidney Allocation System (KAS): A Single Center Study Update Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Kaur N, Kamoun M, Kearns J, Trofe-Clark J, Abt P, Levine M, Goral S. Kidney Transplant Outcomes in Patients with CPRA Values > 98% after Implementation of the New OPTN/UNOS Kidney Allocation System (KAS): A Single Center Study Update [abstract]. https://atcmeetingabstracts.com/abstract/kidney-transplant-outcomes-in-patients-with-cpra-values-98-after-implementation-of-the-new-optn-unos-kidney-allocation-system-kas-a-single-center-study-update/. Accessed November 26, 2024.« Back to 2018 American Transplant Congress