The implementation of the new kidney allocation system and priority of kidneys for cPRA=100% subjects revealed a hierarchy difference in allocation to patients with cPRA=99.45%-100%. Indeed, patients with cPRA >99.95% have been predicted to receive less than one compatible offer per year from all eligible deceased donors. In this study, we report that certain patients with cPRA>99.95% are much more likely to be transplanted than the majority of their counterparts. Identifying these patients by specific features will permit the structured medical workup of those subjects who are most likely to receive offers, optimizing the likelihood these patients will progress to transplantation. At our center, 127 patients with a cPRA of >99.95% are on the waitlist. Ideally, if a subgroup of these patients most likely to receive an offer could be identified, a current medical workup could be maintained. Herein we describe the characteristics of patients with cPRA>99.95% most likely to be offered kidneys from compatible donors.

Methods: We analyzed the HLA profile and demographic data of nine CPRA >99.95% kidney transplant recipients at our center from 12/4/2014 to 1/12/2018 at our center.

Results: There were two major observations among these recipients. 1) These recipients in most cases are likely to have minimal HLA mismatching with their donor (Table 1). 2) We found that 89% (8/9) of these recipients had HLA haplotypes that were among the 100 most common haplotypes of Caucasian donors. Sixty-seven percent (6/9) had haplotypes that were ranked among the top 10 and 56% (5/9) among the top 5 (Table 1).

Conclusion: Under the current kidney allocation system, patients with cPRA>99.95% transplanted at our center have minimal HLA mismatching and frequently carry a common HLA haplotype in the donor population. Transplant programs should consider these factors when determining which cPRA>99.95% candidates warrant a current medical workup.

CITATION INFORMATION: Parsons R., Bumb S., Decker H., Bray R., Gebel H. Identifying Patients with CPRA>99.95% Likely to Be Offered Deceased Donor Kidneys Am J Transplant. 2017;17 (suppl 3).

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