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Highly Sensitized Kidney Transplant Outcomes After the 2014 Kidney Allocation System Change
Jae-Hyung Chang1, Kristen L King1,2, S Ali Husain1,2
1Division of Nephrology, Columbia University, Vagelos College of Physicians and Surgeons, New York, NY, USA.
Progress in Transplantation (Aliso Viejo, Calif.)
|August 2, 2024
Summary
The Kidney Allocation System (KAS) increased kidney transplants for highly sensitized patients without worsening outcomes. While KAS reduced racial disparities, significant inequalities persist for Black patients.
Area of Science:
- Nephrology
- Transplantation Immunology
- Health Services Research
Background:
- The United Network for Organ Sharing implemented the Kidney Allocation System (KAS) in 2014 to address disparities in organ allocation.
- Highly sensitized patients (calculated panel reactive antibody [cPRA] ≥ 97%) face challenges in receiving kidney transplants due to antibody-mediated rejection risks.
- Understanding the impact of KAS on transplant outcomes for highly sensitized individuals and its effect on racial disparities is crucial.
Purpose of the Study:
- To compare outcomes of highly sensitized patients (cPRA ≥ 97%) before and after the implementation of KAS.
- To examine the outcomes of highly sensitized patients relative to low-risk recipients (cPRA < 10%) in the post-KAS era.
- To determine the impact of KAS on racial disparities in kidney transplantation.
Main Methods:
- Retrospective analysis of national registry data.
- Identification of two cohorts of adult candidates waitlisted for deceased donor kidney transplantation during 3-year periods before (2011-2013) and after (2015-2017) KAS implementation.
- Comparison of transplant rates, graft survival, and death-censored graft failure between patient groups and across eras.
Main Results:
- Highly sensitized patients received transplants more frequently post-KAS (N=1238 pre-KAS, N=4687 post-KAS).
- Post-KAS, graft survival in the first year improved for highly sensitized recipients (HR 0.56).
- While racial disparities improved, Black patients remained disproportionately represented among highly sensitized candidates and recipients post-KAS.
Conclusions:
- KAS increased kidney transplantation rates for highly sensitized candidates without compromising overall outcomes.
- Post-KAS, graft survival in the first year improved for highly sensitized recipients.
- Despite improvements, KAS has not fully eliminated racial inequalities in kidney transplantation, with persistent disparities for Black patients.
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