Increased Access to Transplantation of Highly Sensitized Patients Facilitated by the New Kidney Allocation System.
Abdominal Transplant, Montefiore Medical Center, Bronx, NY.
Meeting: 2016 American Transplant Congress
Abstract number: 282
Keywords: Histocompatibility, HLA antibodies, Kidney transplantation
Session Information
Session Name: Concurrent Session: Antibody Mediated Rejection in Kidney Transplantation: De Novo DSA
Session Type: Concurrent Session
Date: Monday, June 13, 2016
Session Time: 4:30pm-6:00pm
Presentation Time: 5:42pm-5:54pm
Location: Ballroom B
The purpose of our study was to evaluate the impact of the new kidney allocation system (KAS 2014) on the access to transplantation of HLA sensitized patients listed at our center.
The number of deceased donor crossmatches (XMs) and the number of transplants performed from Jan 1st to June 30th 2015 (post-KAS) were compared to those performed from Jan 1st to June 30th 2014 (pre-KAS). The criteria for reporting unacceptable HLA antigens to UNET were the same pre- and post-KAS. All patients were transplanted based on a negative flow and/or negative CDC crossmatch.
A total of 575 and 348 deceased donor XMs were performed during post-KAS and pre-KAS intervals, respectively. The percentage of XMs performed on sensitized patients (cPRA>20%) increased from 12% pre-KAS to 26% post-KAS (p<0.0001) (Table 1). This increase was balanced by a lower rate of XMs performed for patients with cPRA lower than 20% (74% post-KAS vs 88% pre-KAS). The distribution of cPRA among patients who received deceased donor kidney transplantation pre- and post-KAS showed a similar trend. Out of 56 patients transplanted post-KAS, 14 patients (25%) had a cPRA>20%, while only 5 patients (9%) of the patients transplanted pre-KAS (N=56) were sensitized (Table 1).
| cPRA (%) | % Crossmatches | % Transplants | ||
| Post-KAS (N=575) | Pre-KAS (N=384) | Post-KAS (N=56) | Pre-KAS (N=56) | |
| 0-20 | 74 | 88 | 75 | 91 |
| 21-50 | 11 | 2 | 5 | 2 |
| 51-80 | 5 | 3 | 9 | 2 |
| 81-98 | 6 | 4 | 5 | 5 |
| >98 | 4 | 3 | 5 | 0 |
| p<0.0001 | p<0.0001 | |||
At a median follow-up of 5 months post-transplantation, clinical outcomes of sensitized patients transplanted post-KAS were favorable, as indicated in Table 2.
| Variable, Post-KAS | Transplants (N=56; cPRA>20%) |
|
Median follow-up (months) |
5 |
|
AMR (%) |
14 |
|
ACR (%) |
21 |
|
Mean serum creatinine (g/dl) |
1.6 |
|
Graft survival (%) |
93 |
|
Patient survival (%) |
93 |
In conclusion, the number of sensitized patients who received donor offers and of those who were transplanted increased significantly at our center with the implementation of the new KAS. This increase was observed for all subgroups of sensitized patients (cPRA>20%). It should be noted, however, that the number of XMs performed post-KAS by the HLA laboratory increased by 65%. This should be considered when evaluating the costs of the new KAS.
CITATION INFORMATION: Colovai A, Ajaimy M, Savchik C, Chan S, Masiakos P, Rocca J, Akalin E. Increased Access to Transplantation of Highly Sensitized Patients Facilitated by the New Kidney Allocation System. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Colovai A, Ajaimy M, Savchik C, Chan S, Masiakos P, Rocca J, Akalin E. Increased Access to Transplantation of Highly Sensitized Patients Facilitated by the New Kidney Allocation System. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/increased-access-to-transplantation-of-highly-sensitized-patients-facilitated-by-the-new-kidney-allocation-system/. Accessed November 22, 2024.« Back to 2016 American Transplant Congress