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Comparative Study
. 2020 Jul;104(7):1456-1461.
doi: 10.1097/TP.0000000000002989.

Posttransplant Outcomes for cPRA-100% Recipients Under the New Kidney Allocation System

Kyle R Jackson  1 , Courtenay Holscher  1 , Jennifer D Motter  1 , Niraj Desai  1 , Allan B Massie  1   2 , Jacqueline Garonzik-Wang  1 , Nada Alachkar  3 , Dorry L Segev  1   2   3
Affiliations
Comparative Study

Posttransplant Outcomes for cPRA-100% Recipients Under the New Kidney Allocation System

Kyle R Jackson et al. Transplantation. 2020 Jul.

Abstract

Background: There is concern in the transplant community that outcomes for the most highly sensitized recipients might be poor under Kidney Allocation System (KAS) high prioritization.

Methods: To study this, we compared posttransplant outcomes of 525 pre-KAS (December 4, 2009, to December 3, 2014) calculated panel-reactive antibodies (cPRA)-100% recipients to 3026 post-KAS (December 4, 2014, to December 3, 2017) cPRA-100% recipients using SRTR data. We compared mortality and death-censored graft survival using Cox regression, acute rejection, and delayed graft function (DGF) using logistic regression, and length of stay (LOS) using negative binomial regression.

Results: Compared with pre-KAS recipients, post-KAS recipients were allocated kidneys with lower Kidney Donor Profile Index (median 30% versus 35%, P < 0.001) but longer cold ischemic time (CIT) (median 21.0 h versus 18.6 h, P < 0.001). Compared with pre-KAS cPRA-100% recipients, those post-KAS had higher 3-year patient survival (93.6% versus 91.4%, P = 0.04) and 3-year death-censored graft survival (93.7% versus 90.6%, P = 0.005). The incidence of DGF (29.3% versus 29.2%, P = 0.9), acute rejection (11.2% versus 11.7%, P = 0.8), and median LOS (5 d versus 5d, P = 0.2) were similar between pre-KAS and post-KAS recipients. After accounting for secular trends and adjusting for recipient characteristics, post-KAS recipients had no difference in mortality (adjusted hazard ratio [aHR]: 0.861.623.06, P = 0.1), death-censored graft failure (aHR: 0.521.001.91, P > 0.9), DGF (adjusted odds ratio [aOR]: 0.580.861.27, P = 0.4), acute rejection (aOR: 0.610.941.43, P = 0.8), and LOS (adjusted LOS ratio: 0.981.161.36, P = 0.08).

Conclusions: We did not find any statistically significant worsening of outcomes for cPRA-100% recipients under KAS, although longer-term monitoring of posttransplant mortality is warranted.

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Conflict of interest statement

DISCLOSURES

The authors of this manuscript have no conflicts of interest to disclose as described by Transplantation

Figures

Figure 1.
Figure 1.. Kidney Donor Profile Index of pre-KAS and post-KAS cPRA-100% Recipients
Median KDPI for cPRA-100% recipients decreased from 35% pre-KAS to 30% post-KAS (p<0.001).
Figure 2.
Figure 2.. Mortality for Pre-KAS and Post-KAS cPRA-100% Recipients
3-year patient mortality was lower for post-KAS cPRA-100% recipients compared to pre-KAS recipients (6.4% vs. 8.6%, p=0.04). However, there were no statistically significant differences in mortality risk after accounting for secular trends and recipient characteristics.
Figure 3.
Figure 3.. Death-censored graft failure for Pre-KAS and Post-KAS cPRA-100% Recipients
3-year death-censored graft failure was lower for post-KAS cPRA-100% recipients compared to pre-KAS recipients (6.3% vs. 9.4%, p=0.005). However, there were no statistically significant differences in graft loss risk after accounting for secular trends and recipient characteristics.
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References

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