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Abstract: TH-PO1180

Temporal Trends in Transplant Modalities Used for Highly Sensitized Kidney Transplant Candidates and Recipients

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Jackson, Kyle R., Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Motter, Jennifer D., Johns Hopkins Hospital, Baltimore, Maryland, United States
  • Segev, Dorry L., Johns Hopkins Hospital, Baltimore, Maryland, United States

Group or Team Name

  • Epidemiology Research Group in Organ Transplantation
Background

Prioritization of highly sensitized (HS) candidates under the Kidney Allocation System (KAS) and expansion of kidney-paired donation (KPD) have broadened the transplant options available to HS candidates.

Methods

To quantify temporal trends in utilization of these differing transplant modalities, we used national SRTR registry data from 2009-2017 to study 45,759 adult HS (cPRA≥80%) waitlisted candidates and 19,003 HS transplant recipients. We used competing risks regression to quantify temporal trends in likelihood of deceased donor kidney transplantation (DDKT), KPD, and non-KPD living donor kidney transplantation (LDKT) for HS candidates over time (Era 1: 01/01/2009-12/31/2011; Era 2: 01/01/2012 – 12/3/2014; Era 3: 12/4/2014 – 12/31/2017).

Results

Although the likelihood of DDKT and KPD increased over time for all HS candidates (adjusted subhazard ratio [aSHR] for Era 3 vs. 1 for DDKT: 1.641.721.80, p<0.001; aSHR for KPD: 1.301.571.88, p<0.001), the likelihood of LDKT decreased over time (aSHR for Era 3 vs. 1: 0.710.820.95, p=0.007). However, these changes affected HS recipients differently depending on their cPRA. For example, an increased proportion of cPRA 80-89% recipients were transplanted with KPD over time (8.6% of candidates in Era 3 vs. 3.8% in Era 1, p<0.001), whereas DDKT was used for fewer recipients (80.1% in Era 3 vs. 86.2% in Era 1). In contrast, an increased proportion of cPRA 98-99.9% and 99.9%+ recipients were transplanted with DDKT (96.2% in Era 3 vs. 59.1% in Era 1 for cPRA 99.9%+, p<0.001), at the expense of fewer recipients being transplanted with either LDKT (1.9% in Era 3 vs. 30.9% in Era 1 for cPRA 99.9%+) or KPD (2.0% in Era 3 vs 10.0% in Era 1 for cPRA 99.9%+).

Conclusion

HS candidates had an increased likelihood of DDKT and KPD over time, although the effect of this varied across cPRA. In the KAS era, the most HS candidates (cPRA 98%+) have seen significant declines in use of KPD and LDKT.

Funding

  • NIDDK Support