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

Julie A. Houp, Karl P. Schillinger, Andrew J. Eckstein, Renato M. Vega, Niraj M. Desai, Bonnie E. Lonze, Annette M. Jackson

Research output: Contribution to journalArticle

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% to 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.

Original languageEnglish (US)
Pages (from-to)49-53
Number of pages5
JournalHuman Immunology
Volume78
Issue number1
DOIs
StatePublished - Jan 1 2017

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Kidney
Antibodies
Transplantation
Transplants
Vulnerable Populations
Phenotype
Antigens

Keywords

  • Calculated Panel Reactive Antibody (CPRA)
  • HLA sensitization
  • Kidney allocation system (KAS)
  • Kidney transplantation
  • Unacceptable antigens

ASJC Scopus subject areas

  • Immunology and Allergy
  • Immunology

Cite this

Casting a smaller net into a bigger donor pool : A single center's experience with the new kidney allocation system. / Houp, Julie A.; Schillinger, Karl P.; Eckstein, Andrew J.; Vega, Renato M.; Desai, Niraj M.; Lonze, Bonnie E.; Jackson, Annette M.

In: Human Immunology, Vol. 78, No. 1, 01.01.2017, p. 49-53.

Research output: Contribution to journalArticle

Houp JA, Schillinger KP, Eckstein AJ, Vega RM, Desai NM, Lonze BE et al. Casting a smaller net into a bigger donor pool: A single center's experience with the new kidney allocation system. Human Immunology. 2017 Jan 1;78(1):49-53. Available from, DOI: 10.1016/j.humimm.2016.11.004

Houp, Julie A.; Schillinger, Karl P.; Eckstein, Andrew J.; Vega, Renato M.; Desai, Niraj M.; Lonze, Bonnie E.; Jackson, Annette M. / Casting a smaller net into a bigger donor pool : A single center's experience with the new kidney allocation system.

In: Human Immunology, Vol. 78, No. 1, 01.01.2017, p. 49-53.

Research output: Contribution to journalArticle

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