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Casting a smaller net into a bigger donor pool: A single center's experience with the new kidney allocation system
Julie A Houp1, Karl P Schillinger1, Andrew J Eckstein1
1Department of Medicine, The Johns Hopkins University, Baltimore, MD, USA.
Human Immunology
|November 29, 2016
Summary
The new kidney allocation system (KAS) improved transplant rates for highly sensitized candidates by adjusting HLA antibody thresholds. However, it did not sufficiently increase transplants for 99% CPRA candidates, highlighting the need for desensitization therapies.
Area of Science:
- Nephrology
- Immunology
- Transplantation Science
Background:
- The new kidney allocation system (KAS) aims to improve transplant rates for broadly human leukocyte antigen (HLA)-sensitized candidates.
- This population often faces immunological barriers to kidney transplantation.
Purpose of the Study:
- To evaluate the impact of the new KAS on transplant rates for highly sensitized kidney candidates at our center.
- To assess the effectiveness of adjusting HLA antibody thresholds and utilizing broader donor pools.
Main Methods:
- Implemented a lower HLA antibody threshold for unacceptable antigens, transitioning from cytotoxicity to flow cytometric crossmatch.
- Increased Calculated Panel Reactive Antibody (CPRA) values and allocation points for sensitized candidates.
- Analyzed changes in transplant rates for candidates in different CPRA categories (99% and 100%).
Main Results:
- Candidates with 100% CPRA experienced increased transplantation rates due to access to larger national donor pools.
- Candidates with 99% CPRA did not show a significant increase in transplantation rates despite regional sharing.
- Inconsistencies within the 100% CPRA cohort (99.99-100.0% CPRA) were identified, indicating potential inequities.
Conclusions:
- The revised KAS and adjusted HLA antibody thresholds successfully increased transplants for some highly sensitized patients.
- Regional sharing was insufficient to overcome transplant barriers for 99% CPRA candidates.
- Desensitization therapies remain crucial for reducing immunological barriers and improving transplant access for the most highly sensitized individuals.
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