P064 Kidney allocation strategy for highly sensitized patients based on epitope virtual crossmatch: Pernambuco experience

Abstract

Aim Brazil has a public transplant program. Potential recipients are ranking by HLA match, age, time in waiting list and PRA > 50%. However, transplantability among highly sensitized patients is 10 times lower than among non-highly sensitized. To investigate the impact of the six first months using new kidney allocation strategy (KAPEviX) on the rate of transplantation of highly sensitized patients in the state of Pernambuco (PE). Methods All histocompatibility data of PE patients were inserted into the EpViX program ( www.epvix.com.br ). Epitope reactivity analysis was accomplished for all sera, to which epitope specificity of the preformed anti-HLA antibody and the cPRA values were recorded. The deceased donors were typed to all loci by PCR SSO. The potential highly sensitized patients for each deceased donation were identified from the official ranking and the EpViX program prioritized those with at least one HLA-DRB1 match, acceptable Epitope Virtual Crossmatch (EvXM) with negative CDC. All patients were monitored post-transplant with SAB tests. Pre-KAPEViX and post-KAPEViX intervals were compared. Results There was an increase in the percentage of deceased-donor kidney transplants received by highly sensitized candidates from 5.9% in 2015 to 18.5% through KAPEViX. KAPEViX prioritized 100 potential patients, and kidneys were effectively allocated to 21 patients. Seventy-seven percent (77%) showed donor specific antibodies and 43% of them had cPRA > 90%. There was only one episode of antibody mediated rejection that responded favorably to the treatment proposed. No death or graft dysfunction occurred so far. Conclusions KAPEViX strategy is adequate to find a compatible donor to highly sensitized recipients assuring better equity without increase the rejection episodes in recipients with donor specific antibodies.