Casting a smaller net into a bigger donor pool: a single center’s experience with the new kidney allocation system

Abstract The new Kidney Allocation System (KAS) provides additional allocation points for candidates with broad HLA sensitization in an effort to increase transplant rates for this underserved population. Following the implementation of KAS, our center lowered the HLA antibody threshold for listing...

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Bibliographic Details
Published in:Human immunology 2017-01, Vol.78 (1), p.49-53
Main Authors: Houp, Julie A, Schillinger, Karl P, Eckstein, Andrew J, Vega, Renato M, Desai, Niraj M, Lonze, Bonnie E, Jackson, Annette M
Format: Article
Language:English
Subjects:
Allergy and Immunology
Calculated Panel Reactive Antibody (CPRA)
Cohort Studies
Government Regulation
Histocompatibility Testing
HLA Antigens - immunology
HLA sensitization
Humans
Immunization
Isoantibodies - metabolism
Kidney allocation system (KAS)
Kidney Transplantation
Retrospective Studies
Tissue and Organ Procurement
Tissue Donors
Transplant Recipients
Treatment Outcome
Unacceptable antigens
United States
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Summary:Abstract The new Kidney Allocation System (KAS) provides additional allocation points for candidates with broad HLA sensitization in an effort to increase transplant rates for this underserved population. Following the implementation of KAS, our center lowered the HLA antibody threshold for listing unacceptable antigens from a cytotoxicity crossmatch level to a flow cytometric crossmatch level increasing Calculated Panel Reactive Antibody (CPRA) values and allocation points, yet restricting acceptable donor HLA phenotypes. As a result, many sensitized candidates were transitioned from 50-98% CPRA categories into the 99% CPRA regional share and 100% CPRA national share categories. Exposure to these larger donor pools significantly increased transplantation with compatible donors for 100% CPRA candidates, but regional sharing was not sufficient to increase transplantation rates for our 99% CPRA candidates. Competition within the 100% CPRA cohort identified inequities for 99.99-100.0% CPRA candidates and highlighted the continued need for desensitization therapies to reduce immunological barriers and provide transplant opportunities for the most highly sensitized candidates.
ISSN:0198-8859
1879-1166
DOI:10.1016/j.humimm.2016.11.004