Assessing the Impact of the New KAS on Transplant Rates in Highly-HLA Sensitized (HS) Patients After Desensitization (Des) 2 Years Post Implementation.
1Kidney Transplant, Cedars-Sinai Medical Center, LA, CA
2HLA Laboratory, Cedars-Sinai Medical Center, LA, CA
Meeting: 2017 American Transplant Congress
Abstract number: A51
Keywords: Highly-sensitized, HLA antibodies, IVIG, Kidney transplantation
Session Information
Session Name: Poster Session A: Clinical Science: Kidney Immunosuppression: Desensitization
Session Type: Poster Session
Date: Saturday, April 29, 2017
Session Time: 5:30pm-7:30pm
Presentation Time: 5:30pm-7:30pm
Location: Hall D1
Introduction: The new KAS aims to improve access to transplantation for HS patients, specifically CPRA 99-100%. Our center has extensive experience w. DES to improve transplant rates in HS patients. Prior to KAS, we transplanted ~3% CPRA 99-100% patients. Here we explore the impact of KAS on transplant rates & outcomes for patients who underwent DES prior to HLA incompatible transplantation. Patients & Methods: Post KAS, waitlisted HS patients (CPRA>80%) who met criteria based on wait time & CPRA points with likely transplant w/in 6M underwent DES with IVIG + rituximab ± PLEX. Acceptable crossmatch criteria included: a negative CDC-CMX at 1:2 dilution, T&B-cell FCMX ≤225MCS and DSA ≤10,000MFI post desensitization. Unacceptable antigens were defined as MFI>15,000. Patient & graft survival as well as freedom from ABMR were compared to patients w. CPRA <80% transplanted concurrently. Transplanted HS patients received induction w. alemtuzumab & maintained with tac/mmf/pred. Results: From 12/23/14 -10/30/16, 68 HS patients {G1: 39 (CPRA 80-98%) and G2: 29 (CPRA 99-100%) received transplants. Briefly, 8% {G1} v. 24% {G2} received 0MM kidneys; CIT was 15.8±6hrs v. 20.5±5hrs; 46% v. 43% were FCMX+/DSA+ @transplant; 59% v. 72% had previous transplants (P=NS). ABMR occurred in 6 patients (16%) in G1 v. 4 patients (14%) in G2. Freedom from ABMR is shown in figure 1, compared to CPRA <80% groups. Patient & graft survival were similar. Conclusions: Rates of transplantation for HS patients with CPRA 99-100% increased from 14% Y1 to 22% Y2, post-KAS implementation, likely d/t increased regional and national access to a compatible donor pool after DES. ABMR rates were 14% in group G2, even after DES. This is likely due to CMX+ @transplant and h/o previous transplant. In addition, patients in the 99-100% CPRA group are likely to have DSA rebound. Patient and graft survival did not differ among the non-sensitized and HS cohorts. Assessing benefits of the new KAS should include data on ABMR and DSA generation post-transplant.
[figure2]
CITATION INFORMATION: Vo A, Williamson S, Myers K, Huang E, Choi J, Zhang X, Peng A, Najjar R, Jordan S. Assessing the Impact of the New KAS on Transplant Rates in Highly-HLA Sensitized (HS) Patients After Desensitization (Des) 2 Years Post Implementation. Am J Transplant. 2017;17 (suppl 3).
To cite this abstract in AMA style:
Vo A, Williamson S, Myers K, Huang E, Choi J, Zhang X, Peng A, Najjar R, Jordan S. Assessing the Impact of the New KAS on Transplant Rates in Highly-HLA Sensitized (HS) Patients After Desensitization (Des) 2 Years Post Implementation. [abstract]. Am J Transplant. 2017; 17 (suppl 3). https://atcmeetingabstracts.com/abstract/assessing-the-impact-of-the-new-kas-on-transplant-rates-in-highly-hla-sensitized-hs-patients-after-desensitization-des-2-years-post-implementation/. Accessed November 21, 2024.« Back to 2017 American Transplant Congress