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Kidney Week

Abstract: PO2590

Post-Transplant Outcomes for Highly Sensitized Kidney Transplant Recipients with Non-Highly Sensitized Recipients in the Era of the New Kidney Allocation System: A Single-Center Case-Control Comparison

Session Information

Category: Transplantation

  • 1902 Transplantation: Clinical

Authors

  • Agarwal, Gaurav, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Mompoint-Williams, Darnell, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Ong, Song Ching, The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Locke, Jayme E., The University of Alabama at Birmingham, Birmingham, Alabama, United States
  • Kumar, Vineeta, The University of Alabama at Birmingham, Birmingham, Alabama, United States

Group or Team Name

  • University of Alabama at Birmingham
Background

The new UNOS kidney allocation system (KAS) of December 2014, gives substantial priority points to highly sensitized (HS) adult kidney transplant recipients (KTR) with cPRA of 99% or higher. There is a concern of worse post-transplant outcomes in HS KTR compared to non-HS KTR. When comparing pre-KAS to post KAS, similar 3-year patient and graft survival has been reported in HS KTR. The comparative outcomes of HS KTR to non-HS KTR in the post KAS era are unknown

Methods

We studied outcomes in HS adult kidney transplant recipients (KTR) and compared them to non-HS KTR in the post KAS era. We included all recipients of deceased donor kidney transplant at the University of Alabama at Birmingham, from December 2014 to March 2020. HS patients were defined as those with cPRA 99% or higher. The HS patients were matched 1:2 with non-HS patients on age, sex, and time of transplant. A Kaplan Meier analysis was performed for patient survival and the combined endpoint of graft and patient survival

Results

A total of 717 deceased donor kidney transplants were performed during the study period, of which 106 HS KTR were identified. The HS patients were more likely to be female (59.4% vs 34%, p <0.001), non-black (42.5% vs 30.9%, p<0.022) and were of similar mean age at transplant (49.9 vs 50.3 years, p=0.46) compared to non-HS patients. The HS-patients were then compared with 228 matched non-HS deceased donor controls. The matched controls had a median cPRA of 0% (IQR 0-29.5%). There was no difference in death (p=0.17) or combined endpoint of death or graft survival (p=0.35) in the two groups (figure 1).

Conclusion

HS patients have similar mortality and graft survival as compared with non-HS controls. The results of our study support continuing to give HS patients priority in organ allocation