title: Low transplantability of 0 blood group and highly sensitized candidates in the Portuguese kidney allocation algorithm: quantifying an old problem in search of new solutions.
abstract: The impact of patient's biological differences in waiting time for kidney transplantation is well known and has been a subject of extensive debate and struggle in transplantation community. Our purpose was to evaluate patient's access to kidney transplantation in Portugal, regarding their degree of allosensitization and blood type. A retrospective cohort study including 1020 candidates for kidney transplantation between 01 January 2010 and 31 December 2011 in transplant unit Centro Hospitalar do Porto was performed. The deceased donor organ offer by blood type decreased with the calculated panel reactive antibody (cPRA) increase for A and B blood groups candidates, while in 0 blood group candidates, a significant reduction in organ offer was only observable in hypersensitized (HS) ones. As a consequence, the median waiting time was also significantly higher in 0 blood group patients, when compared to the remaining groups. However, waiting time increased extensively with cPRA regardless blood type, especially HS patients with increases of 368%, 632%, 486%, and 140% for blood groups A, B, AB, and 0, respectively, when compared to each blood group global median waiting time. Our study shows that important measures need to be undertaken in order to mitigate the huge disadvantage that HS and 0 blood type patients naturally have.
authors.affiliation: Oporto Blood and Transplantation Center, Instituto Português do Sangue e da Transplantacão, Porto, Portugal. sandra.tafulo@ipst.min-saude.pt.
authors.forename: S
authors.identifier: 0000-0002-3911-0245
authors.initials: S
authors.lastname: Tafulo
authors.affiliation: Nephrology and Kidney Transplantation Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Malheiro
authors.affiliation: Nephrology and Kidney Transplantation Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: L
authors.initials: L
authors.lastname: Dias
authors.affiliation: Oporto Blood and Transplantation Center, Instituto Português do Sangue e da Transplantacão, Porto, Portugal.
authors.forename: C
authors.initials: C
authors.lastname: Mendes
authors.affiliation: Oporto Blood and Transplantation Center, Instituto Português do Sangue e da Transplantacão, Porto, Portugal.
authors.forename: E
authors.initials: E
authors.lastname: Osório
authors.affiliation: Nephrology and Kidney Transplantation Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: L S
authors.initials: LS
authors.lastname: Martins
authors.affiliation: Nephrology and Kidney Transplantation Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: J
authors.initials: J
authors.lastname: Santos
authors.affiliation: Nephrology and Kidney Transplantation Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: S
authors.initials: S
authors.lastname: Pedroso
authors.affiliation: Nephrology and Kidney Transplantation Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: M
authors.initials: M
authors.lastname: Almeida
authors.affiliation: Nephrology and Kidney Transplantation Department, Centro Hospitalar do Porto, Hospital de Santo António, Porto, Portugal.
authors.forename: A
authors.initials: A
authors.lastname: Castro-Henriques
mesh_terms: D000017:ABO Blood-Group System / Q000235:genetics* / Q000276:immunology; D000328:Adult; D000465:Algorithms; D000483:Alleles; D000066491:Clinical Decision-Making / Q000941:ethics / Q000379:methods; D005260:Female; D015870:Gene Expression; D006680:HLA Antigens / Q000235:genetics* / Q000276:immunology; D006650:Histocompatibility Testing; D006801:Humans; D007518:Isoantibodies / Q000097:blood; D007676:Kidney Failure, Chronic / Q000235:genetics / Q000276:immunology / Q000401:mortality / Q000628:therapy*; D016030:Kidney Transplantation / Q000379:methods* / Q000401:mortality; D008297:Male; D008875:Middle Aged; D011174:Portugal; D012189:Retrospective Studies; D016019:Survival Analysis; D013997:Time Factors; D014019:Tissue Donors / Q000145:classification / Q000600:supply & distribution*; D014850:Waiting Lists / Q000401:mortality
chemical_list: D000017:ABO Blood-Group System; D006680:HLA Antigens; D007518:Isoantibodies
keywords: blood groups; calculated PRA; hypersensitized patients; kidney transplantation; waiting list