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Clin Transplant. 2019 Nov 5:e13751. doi: 10.1111/ctr.13751. [Epub ahead of print]

Managing highly sensitized renal transplant candidates in the era of kidney paired donation and the new kidney allocation system: Is there still a role for desensitization?

Author information

1
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Rochester, MN, USA.
2
The William J von Liebig Center for Transplantation and Clinical Regeneration, Mayo Clinic, Rochester, MN, USA.
3
Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.
4
New York University Langone Transplant Institute, New York, NY, USA.
5
Cedars Sinai Medical Center, Los Angeles, CA, USA.
6
Transplant Center, Mayo Clinic, Jacksonville, FL, USA.
7
Division of Nephrology and Hypertension, Department of Internal Medicine, Mayo Clinic, Phoenix, AZ, USA.
8
Division of Transplantation Surgery, Department of Medicine, Mayo Clinic, Rochester, MN, USA.

Abstract

Kidney paired donation (KPD) and the new kidney allocation system (KAS) in the United States have led to improved transplantation rates for highly sensitized candidates. We aimed to assess the potential need for other approaches to improve the transplantation rate of highly sensitized candidates such as desensitization. Using the UNOS STAR file, we analyzed transplant rates in a prevalent active waiting-list cohort as of June 1, 2016, followed for 1 year. The overall transplantation rate was 18.9% (11 129/58769). However, only 9.7% (213/2204) of candidates with a calculated panel reactive antibody ≥99.9% received a transplant, and highly sensitized candidates were less likely to receive a living donor transplant. Among candidates with a CPRA ≥ 99.5% (ie. 100%), only 2.5% of transplants were from living donors (13 total, 7 from KPD). Nearly 4 years after KAS (6/30/2018), 1791 actively wait-listed candidates had a CPRA of ≥99.9% and 34.6% (620/1791) of these had ≥5 years of waiting time. Thus, despite KPD and KAS, many sensitized candidates have not been transplanted even with prolonged waiting time. We conclude that candidates with a CPRA ≥ 99.9% and sensitized candidates with an incompatible living donor and prolonged waiting time may benefit from desensitization to improve their ability to receive a transplant.

KEYWORDS:

alloantibody; disparities; organ allocation

PMID:
31769104
DOI:
10.1111/ctr.13751

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