P003 Impact of the new kidney allocation system on the transplant rates of highly sensitized patients. A single center experience

Abstract

Aim Increasing transplant opportunities for difficult-to-match patients was a primary goal of the new kidney allocation system (KAS) implemented on Dec 4, 2014. In this study, we evaluated the impact of KAS on the transplantation rate of sensitized candidates at our center. Methods During Jan 1–Dec 4, 2014 (pre-KAS interval) and Jan 1–Dec 4, 2015 (post-KAS interval), unacceptable HLA antigens for kidney transplant candidates were reported to UNET using the following cutoffs: 5000 MFI for HLA-A, -B and -DR, and 10,000 MFI for HLA-C and -DQ antigens. Deceased donor crossmatches (XMs) were performed by flow cytometry and complement dependent cytotoxicity (CDC). Patients were transplanted based on a negative flow and/or negative CDC XM. Results A total of 613 and 1188 deceased donor XMs were performed during pre- and post-KAS intervals, respectively. The number of XMs performed for sensitized patients (cPRA>0%) increased from 116 (19%) XMs performed pre-KAS to 309 (26%) post-KAS (p 98%, 50–79% and 1–49% (Table 1). During pre- and post-KAS intervals, a total of 115 and 129 patients, respectively, received deceased donor kidney transplantation at our center. As indicated in Table 1, the number of sensitized recipients increased from 16 (14% of pre-KAS transplants) to 32 (25% of post-KAS transplants). The highest increase was seen in patients with cPRA>98% (from 0% to 8%). Transplant outcomes were analyzed in the non-sensitized (N = 97) and sensitized (N = 32) patient groups, who received deceased donor kidney allografts post-KAS. Graft survival, patient survival, creatinine levels and incidence of acute rejection were similar in the two groups. Conclusion The new KAS facilitated a marked increase in the transplant rate of sensitized candidates at our center. The HLA laboratory played a key role in achieving this goal by providing thorough testing and ensuring safe transplantation of difficult-to-match patients. Download : Download high-res image (140KB) Download : Download full-size image