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Early Impact of the New Kidney Allocation System (KAS) in Highly Sensitized Patients.

D. Mompoint-Williams, R. Gaston, G. Jeremy, J. Locke, V. Kumar.

University of Alabama at Birmingham, Birmingham, AL.

Meeting: 2016 American Transplant Congress

Abstract number: C86

Keywords: Allocation, Kidney, Outcome, Sensitization

Session Information

Date: Monday, June 13, 2016

Session Name: Poster Session C: Economics, Public Policy, Allocation, Ethics

Session Time: 6:00pm-7:00pm

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

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  • Impact of the New Kidney Allocation System on Highly Sensitized Patients: Single Center Report.

Purpose

Highly sensitized (HS) patients, defined as a PRA of 99-100% are awarded additional priority points in the new KAS instituted December 2014. We evaluated the impact of these changes at our institution

Methods

HS candidates who received a transplant on or after 12/4/2014 were prospectively monitored. Treatment included induction with anti-thymocyte globulin & IV corticosteroids, maintenance with tacrolimus, mycophenolate & prednisone. Designated care providers followed the HS recipients with more intensive frequency, donor specific anti HLA antibody (DSA) & viral monitoring, implantation & 6 month surveillance biopsies. Outcomes of interest were rate of transplantation, patient & allograft survival and function, acute cellular or antibody mediated rejection (AbMR)

Results

There were 15 HS patients transplanted at our center between 12/5/14-10/5/15. The rate of transplant has risen from 1.6% in 2012 to 12.6% in 2015

60% of these were from national offers in contrast to 37.5% prior to the new KAS

10 of these 15 recipients have >6 months follow up time, with 100% patient & graft survival

Allograft function

No patients have experienced graft dysfunction due to acute cellular or AbMR. Surveillance monitoring found emergence of DSA in 1 patient at day 21, allograft biopsy had evidence of subclinical AbMR treated with plasmapheresis, IVIG & Rituximab (creatinine at last follow up: 0.9 mg/dl). A second recipient has a DSA to CW7 with a MFI 1100 at 3 months and no AbMR on 6 months surveillance biopsy

Conclusions

More national offers under the new KAS have resulted in more transplants for HS candidates, with excellent early patient and allograft survival and function. However these patients are resource intensive, requiring intense individualized monitoring and care. At our single center, the new KAS has benefited the HS candidates.

CITATION INFORMATION: Mompoint-Williams D, Gaston R, Jeremy G, Locke J, Kumar V. Early Impact of the New Kidney Allocation System (KAS) in Highly Sensitized Patients. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Mompoint-Williams D, Gaston R, Jeremy G, Locke J, Kumar V. Early Impact of the New Kidney Allocation System (KAS) in Highly Sensitized Patients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/early-impact-of-the-new-kidney-allocation-system-kas-in-highly-sensitized-patients/. Accessed March 3, 2021.

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