title: Increased access to transplantation of highly sensitized patients under the new kidney allocation system. A single center experience.
abstract: We aimed to investigate the impact of the new kidney allocation system (KAS) on the rate of transplantation of sensitized patients at our center. Pre-KAS and post-KAS intervals were Jan 1st to Dec 3rd 2014 and Jan 1st 2015 to Dec 3rd 2015, respectively. The number of deceased-donor crossmatches performed by flow cytometry increased from 715 pre-KAS to 1188 post-KAS. The percent of crossmatches performed for sensitized patients with calculated panel reactive antibody (cPRA)>0% increased from 19% pre-KAS to 26% post-KAS (p<0.0001). The number of deceased-donor kidney transplants performed at our center increased from 115 pre-KAS to 125 post-KAS (9% increase). There was a significant increase in the percentage of deceased-donor kidney transplants received by sensitized candidates (from 14% to 26% pre- and post-KAS, respectively; p<0.0001). The highest increase was seen in the patients with cPRA>98%, from 0% to 9%, followed by the group with cPRA 50-79%, from 5% to 8%. This increase was balanced by a decrease of 12% in the percentage of non-sensitized recipients, and a modest decrease of 1% in the group with cPRA 1-49%. In conclusion, transplant rate has increased in sensitized patients after KAS. The highest increase was observed among highly sensitized patients (cPRA>98%).
authors.affiliation: Transplant Immunology Laboratory, Department of Surgery, Montefiore Medical Center, United States. Electronic address: acolovai@montefiore.org.
authors.forename: Adriana I
authors.initials: AI
authors.lastname: Colovai
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Maria
authors.initials: M
authors.lastname: Ajaimy
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Layla G
authors.initials: LG
authors.lastname: Kamal
authors.affiliation: Transplant Immunology Laboratory, Department of Surgery, Montefiore Medical Center, United States.
authors.forename: Peter
authors.initials: P
authors.lastname: Masiakos
authors.affiliation: Transplant Immunology Laboratory, Department of Surgery, Montefiore Medical Center, United States.
authors.forename: Shirley
authors.initials: S
authors.lastname: Chan
authors.affiliation: Transplant Immunology Laboratory, Department of Surgery, Montefiore Medical Center, United States.
authors.forename: Christina
authors.initials: C
authors.lastname: Savchik
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Michelle
authors.initials: M
authors.lastname: Lubetzky
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Graciela
authors.initials: G
authors.lastname: de Boccardo
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Alesa
authors.initials: A
authors.lastname: Courson
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Attasit
authors.initials: A
authors.lastname: Chokechanachaisakul
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Jay
authors.initials: J
authors.lastname: Graham
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Stuart
authors.initials: S
authors.lastname: Greenstein
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Milan
authors.initials: M
authors.lastname: Kinkhabwala
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Juan
authors.initials: J
authors.lastname: Rocca
authors.affiliation: Montefiore - Einstein Center for Transplantation, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, United States.
authors.forename: Enver
authors.initials: E
authors.lastname: Akalin
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006085:Graft Survival; D006680:HLA Antigens / Q000235:genetics / Q000276:immunology; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007518:Isoantibodies / Q000276:immunology; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D013997:Time Factors; D014019:Tissue Donors / Q000706:statistics & numerical data*; D009927:Tissue and Organ Procurement / Q000379:methods / Q000706:statistics & numerical data*; D066027:Transplant Recipients / Q000706:statistics & numerical data*; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: HLA sensitization; Kidney allocation system; Kidney transplantation; Panel reactive antibody