ATC Abstracts

American Transplant Congress abstracts

  • Home
  • Meetings Archive
    • 2022 American Transplant Congress
    • 2021 American Transplant Congress
    • 2020 American Transplant Congress
    • 2019 American Transplant Congress
    • 2018 American Transplant Congress
    • 2017 American Transplant Congress
    • 2016 American Transplant Congress
    • 2015 American Transplant Congress
    • 2013 American Transplant Congress
  • Keyword Index
  • Resources
    • 2021 Resources
    • 2016 Resources
      • 2016 Welcome Letter
      • ATC 2016 Program Planning Committees
      • ASTS Council 2015-2016
      • AST Board of Directors 2015-2016
    • 2015 Resources
      • 2015 Welcome Letter
      • ATC 2015 Program Planning Committees
      • ASTS Council 2014-2015
      • AST Board of Directors 2014-2015
      • 2015 Conference Schedule
  • Search

When CPRA Zero is Not the Hero: Does KAS Disadvantage Unsensitized Relisted Patients?

M. Casey, Z. Su, M. Mohamed Ahmed, D. Taber, E. Weeda, T. Morinelli, P. Mauldin, K. Soliman, M. A. Posadas-Salas, V. Rao, D. DuBay

Medical University of South Carolina, Charleston, SC

Meeting: 2020 American Transplant Congress

Abstract number: B-012

Keywords: Allocation, Kidney transplantation, Retransplantation, Sensitization

Session Information

Session Name: Poster Session B: Kidney Deceased Donor Allocation

Session Type: Poster Session

Date: Saturday, May 30, 2020

Session Time: 3:15pm-4:00pm

 Presentation Time: 3:30pm-4:00pm

Location: Virtual

*Purpose: Since the 2014 Kidney Allocation System (KAS) changes, patients with a very high calculated panel reactive antibody (CPRA) have received greater priority in deceased donor kidney transplant (DDKT) allocation. This change was supposed to be offset by minor declines in allocation to low CPRA patients. However, the CPRA makeup of candidates listed for a 2nd DDKT may substantially differ from those listed for their 1st DDKT. With the high priority given to highly sensitized candidates, we hypothesized that KAS disadvantages unsensitized (CPRA<1%) candidates listed for a 2nd DDKT.

*Methods: This retrospective SRTR database study analyzed adult kidney transplant candidates waitlisted between 10/1/09 and 11/30/18. Subjects were stratified by Pre-KAS v. KAS Era, by 1st v. 2nd listing, and by peak CPRA. The primary outcome was DDKT. We used a competing risk multivariable model to adjust for covariates and competing outcomes that included delisting or death.

*Results: A total of 219,860 waitlist candidates were stratified into 4 cohorts: Pre-KAS 1st listing, Pre-KAS 2nd listing, KAS Era 1st listing, and KAS Era 2nd listing (n= 109694, 10750, 91493, and 7923 respectively). In the Pre-KAS period, unsensitized candidates had similar DDKT rates of 21.2% and 22.4% for 1st and 2nd listing respectively. However in the KAS Era, unsensitized candidates saw the DDKT rate drop by nearly half from 1st to 2nd listing (20.0% v. 12.8%, p<.001, Table 1). Our multivariate competing risk model of unsensitized KAS Era candidates showed that 2nd listing was strongly associated with fewer DDKT (H.R. 0.60, 95% C.I. 0.53-0.68, p<0.0001, Fig. 1). Meanwhile, highly sensitized KAS Era candidates (CPRA 98-100%) had the highest DDKT rates of 36.0% and 30.7% for 1st and 2nd listing respectively (Table 1).

*Conclusions: Since the 2014 KAS changes, the DDKT rate significantly fell in unsensitized 2nd listing candidates. This new inequity in DDKT access may be the result of overprioritizing highly sensitized candidates in a subpopulation with a shift towards higher CPRA values. Further research and predictive modeling by the OPTN/UNOS to determine the impact of point allocation changes should be explored.

 border=

 border=

  • Tweet
  • Email
  • Print

To cite this abstract in AMA style:

Casey M, Su Z, Ahmed MMohamed, Taber D, Weeda E, Morinelli T, Mauldin P, Soliman K, Posadas-Salas MA, Rao V, DuBay D. When CPRA Zero is Not the Hero: Does KAS Disadvantage Unsensitized Relisted Patients? [abstract]. Am J Transplant. 2020; 20 (suppl 3). https://atcmeetingabstracts.com/abstract/when-cpra-zero-is-not-the-hero-does-kas-disadvantage-unsensitized-relisted-patients/. Accessed May 11, 2025.

« Back to 2020 American Transplant Congress

Visit Our Partner Sites

American Transplant Congress (ATC)

Visit the official site for the American Transplant Congress »

American Journal of Transplantation

The official publication for the American Society of Transplantation (AST) and the American Society of Transplant Surgeons (ASTS) »

American Society of Transplantation (AST)

An organization of more than 3000 professionals dedicated to advancing the field of transplantation. »

American Society of Transplant Surgeons (ASTS)

The society represents approximately 1,800 professionals dedicated to excellence in transplantation surgery. »

Copyright © 2013-2025 by American Society of Transplantation and the American Society of Transplant Surgeons. All rights reserved.

Privacy Policy | Terms of Use | Cookie Preferences