OR34: THE NEW OPTN KIDNEY ALLOCATION POLICY: INEQUITBLE ACCESS AMONG HIGHLY SENSITIZED PATIENTS

Abstract

In 2013 the OPTN approved a new national allocation policy for deceased donor kidney transplantation giving priority to highly sensitized candidates. Specifically, candidates with cPRA values of 98, 99 and 100% will be given highest priority for local, regional and national sharing, respectively, with the overall objective of improving access to compatible organs. Importantly, identification of HLA-DPB and DQA antigens and antibodies was not incorporated into the new allocation algorithm. Furthermore, this information was not used in the SRTR modeling studies which showed improved access for these candidates. In this study, we document that antibodies against DPB and DQA are prominent among this group of highly sensitized candidates and hypothesize that the presence of these antibodies will lead to a less-than-expected rate of transplantation. Data were collected from 474 wait list (WL) candidates with cPRA >98% at 4 centers (3 East and 1 West coast) and the frequency of DPB and/or DQA antibodies were assessed. Data are summarized in Table 1. On average, 55% of candidates with cPRA >98% possessed antibodies against DPB and/or DQA (range 50–71%). These candidates were predominantly females (66%), non-white minorities (77%) and comprised ∼18% of active WL candidates. Our data show that the majority of patients with cPRA >98% possess antibodies against DPB and/or DQA antigens which are not considered in the new OPTN allocation policy. As such, we expect a high rate of unanticipated positive crossmatches among these candidates and many will not be transplanted with their intended donor. Thus, for this subgroup of sensitized candidates, the intent to increase their access is not likely to be realized. In actuality, the algorithm creates an inequity that, in this study, will predominantly impact female and minority candidates.