Background: Sensitized patients in the past have had prolonged waiting times and greater incidence of death while on the waiting list. On December 4, 2014, UNOS/OPTN activated a new KAS for deceased donor (DD) kidneys that gives priority at the regional level to candidates with calculated panel reactive antibody (CPRA) value = 99% and at the national level to patients with CPRA = 100%. Transplants performed at our center under the new KAS were reviewed to assess outcomes.

Methods: Single center, retrospective data review of patients with CPRA values >98% transplanted between December 4, 2014 and May 18, 2017.

Results: We performed 397 DD kidney transplants since the new KAS and 43 patients with CPRA values >98% were transplanted. Patient characteristics are detailed in Table 1. Median KDPI for these patients was 32%. Ninety-one percent of patients had functioning grafts at median follow-up of 773 days; 6 patients (14%) had de novo DSA to an HLA class I specificity, and 4 patients (9.3%) developed de novo DSA to an HLA class II specificity. Two patients had biopsy-proven antibody mediated rejection, one of which resulted in graft loss. BK viremia occurred in 18.6% of the patients and 39.5% patients required a change in their immunosuppression, primarily decrease or withdrawal of antimetabolite agent due to BK and neutropenia.

Conclusion: Since the new KAS, highly sensitized patients received 10.8 % of the DD Kidney transplants at our center; transplanted patients have excellent short term outcomes with few rejection episodes. BK viremia is a significant concern in this population, possibly due to intense immunosuppression. Long-term follow-up is needed to better evaluate the impact of this new KAS on patient and graft outcomes.

CITATION INFORMATION: Kaur N., Kamoun M., Kearns J., Trofe-Clark J., Abt P., Levine M., Goral S. Kidney Transplant Outcomes in Patients with CPRA Values > 98% after Implementation of the New OPTN/UNOS Kidney Allocation System (KAS): A Single Center Study Update Am J Transplant. 2017;17 (suppl 3).

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