TY - JOUR
T1 - How do highly sensitized patients get kidney transplants in the United States? Trends over the last decade
AU - Jackson, Kyle R.
AU - Motter, Jennifer D.
AU - Kernodle, Amber
AU - Desai, Niraj
AU - Thomas, Alvin G.
AU - Massie, Allan B.
AU - Garonzik-Wang, Jacqueline M.
AU - Segev, Dorry L.
N1 - Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/8/1
Y1 - 2020/8/1
N2 - Prioritization of highly sensitized (HS) candidates under the kidney allocation system (KAS) and growth of large, multicenter kidney-paired donation (KPD) clearinghouses have broadened the transplant modalities available to HS candidates. To quantify temporal trends in utilization of these modalities, we used SRTR data from 2009 to 2017 to study 39 907 adult HS (cPRA ≥ 80%) waitlisted candidates and 19 003 recipients. We used competing risks regression to quantify temporal trends in likelihood of DDKT, KPD, and non-KPD LDKT for HS candidates (Era 1: January 1, 2009-December 31, 2011; Era 2: January 1, 2012-December 3, 2014; Era 3: December 4, 2014-December 31, 2017). Although the likelihood of DDKT and KPD increased over time for all HS candidates (adjusted subhazard ratio [aSHR] Era 3 vs 1 for DDKT: 1.741.851.97, P <.001 and for KPD: 1.702.202.84, P <.001), the likelihood of non-KPD LDKT decreased (aSHR: 0.690.820.97, P =.02). However, these changes affected HS recipients differently based on cPRA. Among recipients, more cPRA 98%-99.9% and 99.9%+ recipients underwent DDKT (96.2% in Era 3% vs 59.1% in Era 1 for cPRA 99.9%+), whereas fewer underwent non-KPD LDKT (1.9% vs 30.9%) or KPD (2.0% vs 10.0%). Although KAS increased DDKT likelihood for the most HS candidates, it also decreased the use of non-KPD LDKT to transplant cPRA 98%+ candidates.
AB - Prioritization of highly sensitized (HS) candidates under the kidney allocation system (KAS) and growth of large, multicenter kidney-paired donation (KPD) clearinghouses have broadened the transplant modalities available to HS candidates. To quantify temporal trends in utilization of these modalities, we used SRTR data from 2009 to 2017 to study 39 907 adult HS (cPRA ≥ 80%) waitlisted candidates and 19 003 recipients. We used competing risks regression to quantify temporal trends in likelihood of DDKT, KPD, and non-KPD LDKT for HS candidates (Era 1: January 1, 2009-December 31, 2011; Era 2: January 1, 2012-December 3, 2014; Era 3: December 4, 2014-December 31, 2017). Although the likelihood of DDKT and KPD increased over time for all HS candidates (adjusted subhazard ratio [aSHR] Era 3 vs 1 for DDKT: 1.741.851.97, P <.001 and for KPD: 1.702.202.84, P <.001), the likelihood of non-KPD LDKT decreased (aSHR: 0.690.820.97, P =.02). However, these changes affected HS recipients differently based on cPRA. Among recipients, more cPRA 98%-99.9% and 99.9%+ recipients underwent DDKT (96.2% in Era 3% vs 59.1% in Era 1 for cPRA 99.9%+), whereas fewer underwent non-KPD LDKT (1.9% vs 30.9%) or KPD (2.0% vs 10.0%). Although KAS increased DDKT likelihood for the most HS candidates, it also decreased the use of non-KPD LDKT to transplant cPRA 98%+ candidates.
KW - clinical research/practice
KW - donors and donation: deceased
KW - donors and donation: paired exchange
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - panel reactive antibody (PRA)
KW - registry/registry analysis
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U2 - 10.1111/ajt.15825
DO - 10.1111/ajt.15825
M3 - Article
C2 - 32065704
AN - SCOPUS:85081716943
SN - 1600-6135
VL - 20
SP - 2101
EP - 2112
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 8
ER -