Currently the United States kidney allocation system gives priority to candidates with a CPRA of 100% by giving them additional allocation points and providing national sharing of matched kidneys. CPRA is calculated based on allele frequencies in the donor population and includes HLA A, B, C, DR and DQB antigens. In reality CPRA is not an integer value and is calculated to multiple decimal points. CPRA of 100% includes any CPRA calculation greater than or equal to 99.5%. This study sought to understand the relationship between the actually CPRA by decile groups in candidates whose maximum CPRA qualifies them for the 100% CPRA designation and the likelihood of receiving a deceased donor transplant. All kidney alone candidates on the waiting list as of December 4, 2014 onward, the date of implementation of the new allocation system, and whose maximum CPRA qualified them for the 100% designation were selected and included in the analysis (9228 candidates). The distribution of candidates based on CPRA is highly skewed toward the highest values with over 50% of candidates having a CPRA greater than 99.94% and over 20% of candidates having a CPRA of over 99.99%. The Kaplan Meier analysis of decile groups of CPRA shows that the highest 30% of CPRA candidates have a low likelihood of receiving a deceased donor transplant. Cox analysis revealed that your decile of CPRA was the most important determinant of receiving a deceased donor transplant. This data suggests that within the 100% CPRA category the actual numeric CPRA out to 3 or 4 decimal points should be included to determine the best strategies for transplant in this category. Very high CPRAs were unlikely to receive a deceased donor transplant in reasonable time frame even with the new rules and probably require a different strategy if they are to be transplanted.

CITATION INFORMATION: Keith D. Parsing the 100% CPRA Kidney Transplant Candidates, Who Gets Transplanted? Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress