*Purpose: Sensitization is frequent after an allograft fails and makes re-transplant difficult for many patients.

*Methods: We performed a cross-sectional chart review of patients who were re-listed for repeat kidney transplant at 2 transplant centers, analyzing the CPRA using luminex SAB at two time points: 1) time of listing in pre-emptive patients or at start of HD in failed transplants and 2) CPRA at most recent evaluation. Patients with a CPRA of <20 at time of listing or start of HD were then subdivided into those who developed CPRA >20 (Increased CPRA group) and those who remained with CPRA <20 at most recent evaluation (Stable Low CPRA group).

*Results: A total of 192 failing allografts between 2 centers were reviewed. Figure 1 demonstrates the distribution of the most recent CPRA between the 192 allografts, of these 94 were sensitized at time of graft loss and remained sensitized with CPRA>20%.

The remaining 98 were non sensitized at time of graft loss (CPRA<20%) and of these 54 patients (55.1%) remained with stable low CPRA <20% while 44 (44.9%) experienced an increase in the CPRA (Figure 2) during a median of 2.5 years of follow-up.

Risk factors for an increase in CPRA were Black race and being taken off immunosuppression from the time of listing/HD start to most recent CPRA measurement (Table 1). Patients not currently on HD were more likely to have Stable Low CPRA.

*Conclusions: There is heterogeneity in the CPRA levels following graft loss and with time, a greater proportion of patients become highly sensitized. Absence of immunosuppression post graft failure is a risk factor for sensitization. Future studies will elucidate the risk factors for an increase in CPRA as well as the optimal management of immunosuppressive therapy following graft loss.

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