*Purpose: In light of changes in donor/recipient case-mix and increased cold ischemia times under KAS, there is some concern that cPRA 100% recipients might be doing poorly under KAS.

*Methods: We used granular, single-center data on 109 cPRA 100% deceased donor kidney transplant (DDKT) recipients to study post-KAS post-transplant outcomes not readily available in national registry data.

*Results: The mean age was 46.7 ± 13.1 years, 39 (35.8%) were female, 49 (45%) were Caucasian, 47 (43.1%) had a glomerular cause of end-stage renal disease, and 76 (69.7%) had a history of a prior transplant. In total, 53 recipients (46.8%) had positive DSA at the time of transplant, 46 recipients (86.8%) had DSAs below positive flow cytometric crossmatch level, and only 7 recipients (13.2%) had DSAs that were sufficient to yield a positive flow cytometric crossmatch. We found that three-year patient (96.4%) and death-censored graft survival (96.8%) was excellent. We also found that cPRA 100% recipients had a relatively low incidence of T-cell mediated rejection (TCMR) (17.4%) and antibody mediated rejection (AMR) (13.8%). TCMR episodes tended to be relatively mild – 52.4% (11 episodes) were borderline, 26.3% (5 episodes) were grade 2, and none were grade 3. Only one episode was associated with graft loss, but this was in the context of a mixed rejection. Although only 15 recipients (13.8%) developed an AMR episode, two of these were associated with a graft loss. Despite the rejection episodes, the vast majority of recipients had excellent graft function three years post-transplant (median serum creatinine 1.5 mg/dL) (Figure).

*Conclusions: cPRA 100% DDKT recipients are doing well under KAS, although every effort should be made to prevent AMR to ensure long-term outcomes remain excellent.

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