Abstract: FR-PO1028
Impact of the Kidney Allocation System (KAS) in Highly Sensitized Patients
Session Information
- Transplantation: Donor-Candidate Assessment and Predictors of Outcome
November 03, 2017 | Location: Hall H, Morial Convention Center
Abstract Time: 10:00 AM - 10:00 AM
Category: Transplantation
- 1702 Transplantation: Clinical and Translational
Authors
- Kumar, Vineeta, University of Alabama at Birmingham , Birmingham, Alabama, United States
- Locke, Jayme E., University of Alabama at Birmingham , Birmingham, Alabama, United States
- Gaston, Robert S., University of Alabama at Birmingham , Birmingham, Alabama, United States
Background
Highly sensitized (HS) patients, defined as a PRA of 99-100% are awarded additional priority points in the new KAS instituted December 2014. We evaluated the impact of these changes at our institution at 1 and 2 year post transplantation
Methods
HS candidates who received a transplant on or after 12/4/2014 were prospectively monitored. Treatment included induction with anti-thymocyte globulin & IV corticosteroids, maintenance with tacrolimus, mycophenolate & prednisone. Designated care providers followed the HS recipients with more intensive frequency, donor specific anti HLA antibody (DSA) & viral monitoring, implantation & 6 month surveillance biopsies. Outcomes of interest were rate of transplantation, patient & allograft survival and function, acute cellular or antibody mediated rejection (AbMR). and were compared in a matched control population in a 1:2 fashion for age, race, and time of transplant.
Results
There were 15 HS patients transplanted between 12/8/14-10/5/15. The rate of transplant has risen from 1.6% in 2012 to 12.6% in 2015.60% of these were from national offers in contrast to 37.5% in the past. All 15 recipients have >1 year follow up time with 100% patient & graft survival. 12 out of 15 have 2 year follow up time with 2 graft losses (for recurrent FSGS) and 1 death for sepsis in this group. Rate of patient and graft survial in the matched cohort was 100% at 1 & 2 years post transplant. Graft function was equivalent in the two groups with serum creatinine (1.4vs.1.6mg/dl, Pvalue 0.7), eGFR (52vs.48ml/min/m2, pvalue 0.9), random urine protein/creatinine ratio (1.1vs.2.3). Rate of denovo DSA formation at 2 years was similar in the two groups at 23vs.26%, p value 0.1. All the high PRA patients in this study were followed by a specialized team with an average of 16 clinic visits per patient vs. 9 in the control population
Conclusion
There has been a shift to increased national offers under the new KAS within the HS candidates at our institution as was intended by the new KAS. All of them have had acceptable early patient and allograft survival and function with intensive and individualized monitoring and follow up. However care of these patients is very resource itensive and needs a dedicated and specialized group of care givers for post transplant care for a successful outcome that benefits a very specific subset of patients.