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?
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.
['Schinstock|Carrie A|CA|0000-0002-3274-3277', 'Smith|Byron H|BH|0000-0001-9318-2437', 'Montgomery|Robert A|RA|', 'Jordan|Stanley C|SC|', 'Bentall|Andrew J|AJ|', 'Mai|Martin|M|', 'Khamash|Hasan A|HA|', 'Stegall|Mark D|MD|0000-0002-1392-0792']
D000328:Adult D003888:Desensitization, Immunologic D046148:Donor Selection D005260:Female D005500:Follow-Up Studies D006680:HLA Antigens D006650:Histocompatibility Testing D006801:Humans D007676:Kidney Failure, Chronic D016030:Kidney Transplantation D019520:Living Donors D008297:Male D008875:Middle Aged D040841:Resource Allocation D012189:Retrospective Studies D009927:Tissue and Organ Procurement D066027:Transplant Recipients D014481:United States
alloantibody disparities organ allocation