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Transplanting the Extremely Sensitized Patient: The University of Wisconsin Experience with the New Kidney Allocation System.

E. Grodstein, R. Bennett, J. Anderson, G. Press, A. Djamali, D. Kaufman, R. Redfield.

Department of Surgery, Division of Transplantation, University of Wisconsin, Madison, WI.

Meeting: 2016 American Transplant Congress

Abstract number: B278

Keywords: Allocation, Panel reactive antibodies, Sensitization

Session Information

Session Name: Poster Session B: Liver: MELD, Allocation and Donor Issues (DCD/ECD)

Session Type: Poster Session

Date: Sunday, June 12, 2016

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

 Presentation Time: 6:00pm-7:00pm

Location: Halls C&D

Background: The new UNOS kidney allocation system (KAS) prioritizes the transplant of highly sensitized patients with a calculated Panel Reactive Antibody (cPRA) ≥80 and extremely sensitized patients with a cPRA ≥98%. However, the actual effects of the new KAS on individual centers are currently unknown.

Methods: This is a single center retrospective review of deceased donor renal transplants in patients with a PRA ≥ 80 performed during the 6 months prior to the implementation of the new KAS (pre-KAS) and 6 months after the implementation of the new KAS (post-KAS).

Results: No significant increase in the number of patients transplanted with a cPRA ≥ 80% was noted, 25% (20/80) in the pre-KAS cohort compared to 23% (17/74) in the post-KAS cohort (p=0.36). However, when examining only patients with a cPRA≥ 98% there was a significant increase from 8.8% (7/80) pre-KAS compared to 23% (17/74) post-KAS, (p<0.001). Thus, we observed an increase in average PRA for highly sensitized patients of 8.2% (from 91.6 to 99.8%, p<0.001). Additionally, there was a significant increase in the number of imported kidneys for highly sensitized patients, from 25% (5/20) in the pre-KAS cohort to 88.2% (15/17) in the post-KAS cohort, p=<0.001. Two additional imported kidneys in the post-KAS cohort were not transplanted due to a positive crossmatch and instead went to non-sensitized, back up patients. The increase in imported kidneys was associated with an increase in the average cold ischemic time (CIT) from 15.5 ± 6.1hrs pre-KAS to 21.7 ± 6.48hrs post-KAS, p=0.01. This was not, however, associated with an increase in delayed graft function (DGF), p=0.28. Furthermore, there was no difference in the kidney donor profile index (KDPI) between the two groups, 30±22% pre-KAS and 27±15% post-KAS, respectively, p=0.74. Importantly, no graft losses or patient deaths were observed in either group.

Conclusions: The new KAS has led to a significant increase in patients transplanted with a cPRA ≥ 98%. However, it has also been accompanied by a significant reduction in patients transplanted with a cPRA between 80% and 98%. Despite a higher percentage of imported kidneys with longer CIT and higher PRA, we report excellent short-term outcomes in the post-KAS. More study is needed to determine the long-term outcomes of extremely sensitized patients transplanted within the new KAS.

CITATION INFORMATION: Grodstein E, Bennett R, Anderson J, Press G, Djamali A, Kaufman D, Redfield R. Transplanting the Extremely Sensitized Patient: The University of Wisconsin Experience with the New Kidney Allocation System. Am J Transplant. 2016;16 (suppl 3).

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To cite this abstract in AMA style:

Grodstein E, Bennett R, Anderson J, Press G, Djamali A, Kaufman D, Redfield R. Transplanting the Extremely Sensitized Patient: The University of Wisconsin Experience with the New Kidney Allocation System. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/transplanting-the-extremely-sensitized-patient-the-university-of-wisconsin-experience-with-the-new-kidney-allocation-system/. Accessed May 31, 2025.

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