title: Outcomes in the highest panel reactive antibody recipients of deceased donor kidneys under the new kidney allocation system.
abstract: Since the institution of the new kidney allocation system in December 2014, kidney transplant candidates with the highest calculated panel reactive antibodies (cPRA) of 99-100 have been transplanted at much higher rates. However, concerns have been raised that outcomes in these patients might be impaired due to higher immunological risk and longer cold ischemia times resulting from long-distance sharing of kidneys. Here, we compare outcomes at the University of Wisconsin between study patients with cPRA 99-100 and all other recipients of deceased donor kidneys transplanted between 12/04/2014 and 12/31/2015. All patients had at least 6 months post-transplant follow-up. The mean follow-up was 13.9±3 months in cPRA ≥99% and 12.3±3.5 months in cPRA ≤98%. There was a total of 152 transplants, 25 study patients, and 127 controls. No statistically significant differences were found between the two groups in delayed graft function, rejection, kidney function, graft and patient survival, or infections. We conclude that transplanting the most highly sensitized patients with kidneys shared outside their local donation service areas is associated with excellent short-term outcomes that are comparable to controls.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Sandesh
authors.initials: S
authors.lastname: Parajuli
authors.affiliation: Division of Transplant Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Robert R
authors.initials: RR
authors.lastname: Redfield
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.|Department of Population Health Sciences, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Brad C
authors.initials: BC
authors.lastname: Astor
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Arjang
authors.initials: A
authors.lastname: Djamali
authors.affiliation: Division of Transplant Surgery, University of Wisconsin Hospital and Clinics, Madison, WI, USA.
authors.forename: Dixon B
authors.initials: DB
authors.lastname: Kaufman
authors.affiliation: Division of Nephrology, Department of Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
authors.forename: Didier A
authors.initials: DA
authors.lastname: Mandelbrot
mesh_terms: D002102:Cadaver; D050377:Cold Ischemia; D046148:Donor Selection; D005260:Female; D005500:Follow-Up Studies; D006680:HLA Antigens / Q000276:immunology*; D006291:Health Policy; D006650:Histocompatibility Testing / Q000379:methods; D006801:Humans; D007518:Isoantibodies / Q000276:immunology*; D016030:Kidney Transplantation; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D012189:Retrospective Studies; D014019:Tissue Donors; D009927:Tissue and Organ Procurement / Q000458:organization & administration*
chemical_list: D006680:HLA Antigens; D007518:Isoantibodies
keywords: graft survival; kidney allocation system; sensitization