TY - JOUR
T1 - Outcomes of cPRA 100% deceased donor kidney transplant recipients under the new Kidney Allocation System
T2 - A single-center cohort study
AU - Jackson, Kyle R.
AU - Chen, Jennifer
AU - Kraus, Edward
AU - Desai, Niraj
AU - Segev, Dorry L.
AU - Alachkar, Nada
N1 - Funding Information:
This work was supported by Grant F32DK113719 (Dr Jackson) and K24DK101828 (Dr Segev) from the National Institute of Diabetes and Digestive and Kidney Diseases.
Publisher Copyright:
© 2020 The American Society of Transplantation and the American Society of Transplant Surgeons
PY - 2020/10/1
Y1 - 2020/10/1
N2 - In light of changes in donor/recipient case-mix and increased cold ischemia times under the Kidney Allocation System (KAS), there is some concern that cPRA 100% recipients might be doing poorly under KAS. We used granular, single-center data on 109 cPRA 100% deceased donor kidney transplant (DDKT) recipients to study post-KAS posttransplant outcomes not readily available in national registry data. We found that 3-year patient (96.4%) and death-censored graft survival (96.8%) was excellent. We also found that cPRA 100% recipients had a relatively low incidence of T cell–mediated rejection (9.2%) and antibody-mediated rejection (AMR) (13.8%). T cell–mediated rejection episodes tended to be relatively mild—50% (5 episodes) were grade 1, 50% (5 episodes) were grade 2, and none were grade 3. Only 1 episode was associated with graft loss, but this was in the context of a mixed rejection. Although only 15 recipients (13.8%) developed an AMR episode, 2 of these were associated with a graft loss. Despite the rejection episodes, the vast majority of recipients had excellent graft function 3 years posttransplant (median serum creatinine 1.5 mg/dL). In conclusion, cPRA 100% DDKT recipients are doing well under KAS, although every effort should be made to prevent AMR to ensure long-term outcomes remain excellent.
AB - In light of changes in donor/recipient case-mix and increased cold ischemia times under the Kidney Allocation System (KAS), there is some concern that cPRA 100% recipients might be doing poorly under KAS. We used granular, single-center data on 109 cPRA 100% deceased donor kidney transplant (DDKT) recipients to study post-KAS posttransplant outcomes not readily available in national registry data. We found that 3-year patient (96.4%) and death-censored graft survival (96.8%) was excellent. We also found that cPRA 100% recipients had a relatively low incidence of T cell–mediated rejection (9.2%) and antibody-mediated rejection (AMR) (13.8%). T cell–mediated rejection episodes tended to be relatively mild—50% (5 episodes) were grade 1, 50% (5 episodes) were grade 2, and none were grade 3. Only 1 episode was associated with graft loss, but this was in the context of a mixed rejection. Although only 15 recipients (13.8%) developed an AMR episode, 2 of these were associated with a graft loss. Despite the rejection episodes, the vast majority of recipients had excellent graft function 3 years posttransplant (median serum creatinine 1.5 mg/dL). In conclusion, cPRA 100% DDKT recipients are doing well under KAS, although every effort should be made to prevent AMR to ensure long-term outcomes remain excellent.
KW - clinical research/practice
KW - health services and outcomes research
KW - kidney disease
KW - kidney transplantation/nephrology
KW - panel reactive antibody (PRA)
KW - rejection
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U2 - 10.1111/ajt.15956
DO - 10.1111/ajt.15956
M3 - Article
C2 - 32342630
AN - SCOPUS:85085370324
SN - 1600-6135
VL - 20
SP - 2890
EP - 2898
JO - American Journal of Transplantation
JF - American Journal of Transplantation
IS - 10
ER -