Abstract
Aim In the 5 months after implementation of the new kidney allocation system (KAS), import kidney offers to 100% cPRA renal transplant candidates (RTC) have increased due to prioritization with an additional 212 points. We noted that while some RTC were receiving multiple provisional offers, other patients were not receiving any. We hypothesized that the patients receiving fewer offers had more unacceptable antigens (UA) entered in UNet, had a less common blood type, or had UA against broad specificities. Methods Active RTC with 100% cPRA from a single center were examined for: total numbers of class I and class II UAs; high frequency broad UAs such as Bw4, Bw6, DR52, etc.; wait time on 12/4/14; expected post-transplant survival (EPTS) score; and ABO blood type. DQA and DPB UAs were also examined, although they can’t be entered in UNet. RTC were stratified by number of offers into 3 groups (0, 1–2, and ⩾ 4 offers), with differences analyzed using Students t-test. Three RTC transplanted within 1 month of KAS were omitted. Results Comparisons are shown in Table 1. The group with 0 offers had a significantly greater number of class I UAs compared to the other groups. For class II UAs, the 0 and 1–2 groups had a significantly greater number than the ⩾ 4 group (p = 0.002). Closer analysis of class II UAs showed that the ⩾ 4 group had a lower incidence of DR52 UA (17%) vs the other groups (50% and 63%). DR51 UA had an incidence of 50% in the 2 groups with the fewest offers, compared to 33% in the ⩾ 4 group. DR53, Bw4, Bw6, Cw, DQ, DPB, mean EPTS score, wait time, and ABO were not significantly different between groups. Conclusion Although this is a single center study with small numbers, these findings may be reproduced with national data. RTC with many UAs may have an extremely narrow window of acceptable mismatches (MM). Donors with 0 MM at one or more loci or with unusual HLA phenotypes may be their only source of offers. Additional strategies may be needed, including sufficient additional points to achieve allocation when there are 0MM at the HLA-A or -B loci. Download : Download full-size image
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