Eplet-based virtual PRA increases transplant probability in highly-sensitized patients

Area of Science:

• Nephrology
• Immunology
• Transplantation

Background:

• Reduced access to kidney transplantation (KTx) for highly-sensitized (HS) patients is a significant challenge.
• Accurate assessment of donor-specific antibodies is crucial for HS patients awaiting KTx.

Purpose of the Study:

• To evaluate the impact of three different calculated panel reactive antibody (cPRA) calculations on donor offer availability for HS patients.
• To compare traditional cPRA assessments with eplet-based analysis for HS kidney transplant candidates.

Main Methods:

• Included 157 HS patients on the KTx waiting list as of January 1, 2020.
• Calculated total vPRA (vPRAt) and current vPRA (vPRAc) using a 1k MFI cut-off.
• Assessed eplet vPRA (vPRAe) using HLAMatchmaker and HLAfusion software for all SAB assays.

Main Results:

• Patients with 100% cPRA were more likely to be re-transplant candidates, had higher PRA-CDC, and longer dialysis vintage.
• Reclassification to a lower cPRA group occurred in 45% (vPRAt to vPRAc), 79% (vPRAt to vPRAe), and 51% (vPRAc to vPRAe).
• Eplet-based cPRA (vPRAe) significantly altered the estimated number of match runs needed for donor probability compared to traditional methods.

Conclusions:

• Traditional total or current cPRA calculations negatively impact HS patients by reducing KTx probability.
• Eplet-based cPRA analysis offers a more accurate assessment, potentially increasing transplant opportunities for HS patients.
• Implementing eplet-based analysis can mitigate prolonged waiting times for highly-sensitized kidney transplant candidates.