Send to

Choose Destination
Hum Immunol. 2017 Jan;78(1):49-53. doi: 10.1016/j.humimm.2016.11.004. Epub 2016 Nov 24.

Casting a smaller net into a bigger donor pool: A single center's experience with the new kidney allocation system.

Author information

Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
Department of Surgery, The Johns Hopkins University, Baltimore, MD, USA.
Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA. Electronic address:


The new kidney allocation system (KAS) provides additional allocation points for candidates with broad HLA sensitization in an effort to increase transplant rates for this underserved population. Following the implementation of KAS, our center lowered the HLA antibody threshold for listing unacceptable antigens from a cytotoxicity crossmatch level to a flow cytometric crossmatch level increasing Calculated Panel Reactive Antibody (CPRA) values and allocation points, yet restricting acceptable donor HLA phenotypes. As a result, many sensitized candidates were transitioned from 50% to 98% CPRA categories into the 99% CPRA regional share and 100% CPRA national share categories. Exposure to these larger donor pools significantly increased transplantation with compatible donors for 100% CPRA candidates, but regional sharing was not sufficient to increase transplantation rates for our 99% CPRA candidates. Competition within the 100% CPRA cohort identified inequities for 99.99-100.0% CPRA candidates and highlighted the continued need for desensitization therapies to reduce immunological barriers and provide transplant opportunities for the most highly sensitized candidates.


Calculated Panel Reactive Antibody (CPRA); HLA sensitization; Kidney allocation system (KAS); Kidney transplantation; Unacceptable antigens

[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center