P186 Impact on transplant centres in Victoria, Australia of the introduction of CPRA

Abstract

Aim To evaluate the effect of the change in cPRA calculation in the NOMS from March 1st 2016 on kidney transplant allocation, in particular with respect to highly sensitised patients. Methods Analysis of data from the NOMS describing kidney transplants performed over 2 equal time periods: 1 March 2015–29 February 2016 (prior to the change in cPRA calculation) and 1 March 2016–28 February 2017 (after the change in cPRA calculation). Recipients of multiple organ transplants (apart from multiple kidneys) were excluded as the allocation process differs in these patients. P values were calculated from chi-square analysis, with the null hypothesis of no change in proportions between the time periods. Results The change in systems resulted in a mean increase of 12% in the “PRA” considered in the allocation algorithm, although the median change was 0 (as the majority of patients had no antibodies). Of patients on the waiting list at the time of the change, 41 (3.3%) had a documented PRA over 80%, which is the threshold for increased points according to the algorithm. With the changed method in the same group, 199 (16%) had a PRA over 80%, a 4-5-fold increase. The change resulted in a number of “hidden” sensitised patients becoming “visible” to the algorithm- eg 53 patients (4.3%) increased their PRA by 80% or more with the change, meaning that they would qualify for bonus allocation points even if their PRA was 0 by the previous system. Data on actual transplants revealed that the number of patients transplanted who were “highly sensitised” by the cPRA calculation rose from 24/201 (11.9%) to 56/240 (23.3%) (p Conclusions The change in cPRA calculation method has resulted in a significant increase in transplantation for highly sensitised patients. Significant variation was found between ABO blood groups in recipients, which warrants further investigation.