TY - JOUR
T1 - The national landscape of deceased donor kidney transplantation for the highly sensitized
T2 - Transplant rates, waitlist mortality, and posttransplant survival under KAS
AU - Jackson, Kyle R.
AU - Covarrubias, Karina
AU - Holscher, Courtenay M.
AU - Luo, Xun
AU - Chen, Jennifer
AU - Massie, Allan B.
AU - Desai, Niraj
AU - Brennan, Daniel C.
AU - Segev, Dorry L.
AU - Garonzik-Wang, Jacqueline
N1 - Funding Information:
This work was supported by grant numbers F32DK113719 (Jackson), F32DK109662 (Holscher), K01DK101677 (Massie), RO1DK098431 (Segev), K24DK101828 (Segev), and K23DK115908 (Garonzik‐ Wang) from the National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK). Ms. Covarrubias is supported by a Doris Duke Clinical Research Mentorship Grant. Dr. Holscher is supported by the American College of Surgeons Resident Research Scholarship. Dr. Garonzik‐Wang is supported by a Clinician Scientist Development Award from the Doris Duke Charitable Research Foundation. The analyses described here are the responsibility of the authors alone and do not necessarily reflect the views or policies of the Department of Health and Human Services, nor does mention of trade names, commercial products or organizations imply endorsement by the U.S. Government. The data reported here have been supplied by the Minneapolis Medical Research Foundation (MMRF) as the contrac‐ tor for the Scientific Registry of Transplant Recipients (SRTR). The interpretation and reporting of these data are the responsibility of the author(s) and in no way should be seen as an official policy of or interpretation by the SRTR or the U.S. Government.
PY - 2019/4
Y1 - 2019/4
N2 - Deceased donor kidney transplantation (DDKT) rates for highly sensitized (HS) candidates increased early after implementation of the Kidney Allocation System (KAS) in 2014. However, this may represent a bolus effect, and a granular investigation of the current state of DDKT for HS candidates remains lacking. We studied 270 722 DDKT candidates from the SRTR from 12/4/2011 to 12/3/2014 (“pre-KAS”) and 12/4/2014 to 12/3/2017 (“post-KAS”), analyzing DDKT rates for HS candidates using adjusted negative binomial regression. Post-KAS, candidates with the highest levels of sensitization had an increased DDKT rate compared with pre-KAS (cPRA 98% adjusted incidence rate ratio [aIRR]: 1.27 1.77 2.46 P =.001, cPRA 99% aIRR: 3.18 4.36 5.98 P <.001, cPRA 99.5–99.9% aIRR: 16.91 24.29 34.89 P <.001, and cPRA 99.9%+ aIRR: 8.79 11.58 15.26 P <.001). To determine whether these changes produced more equitable access to DDKT, we compared DDKT rates of HS to non-HS candidates (cPRA 0–79%). Post-KAS, cPRA, 98% candidates had an equivalent DDKT rate (aIRR: 0.65 0.94 1.36 , P =.8) to non-HS candidates, whereas 99% candidates had a higher DDKT rate (aIRR: 1.19 1.68 2.38 , P =.02). Although cPRA 99.5–99.9% candidates had an increased DDKT rate (aIRR: 2.46 3.50 4.98 , P <.001) compared to non-HS candidates, cPRA 99.9%+ candidates had a significantly lower DDKT rate (aIRR: 0.29 0.40 0.56 , P <.001). KAS has improved access to DDKT for HS candidates, although substantial imbalance exists between cPRA 99.5–99.9% and 99.9%+ candidates.
AB - Deceased donor kidney transplantation (DDKT) rates for highly sensitized (HS) candidates increased early after implementation of the Kidney Allocation System (KAS) in 2014. However, this may represent a bolus effect, and a granular investigation of the current state of DDKT for HS candidates remains lacking. We studied 270 722 DDKT candidates from the SRTR from 12/4/2011 to 12/3/2014 (“pre-KAS”) and 12/4/2014 to 12/3/2017 (“post-KAS”), analyzing DDKT rates for HS candidates using adjusted negative binomial regression. Post-KAS, candidates with the highest levels of sensitization had an increased DDKT rate compared with pre-KAS (cPRA 98% adjusted incidence rate ratio [aIRR]: 1.27 1.77 2.46 P =.001, cPRA 99% aIRR: 3.18 4.36 5.98 P <.001, cPRA 99.5–99.9% aIRR: 16.91 24.29 34.89 P <.001, and cPRA 99.9%+ aIRR: 8.79 11.58 15.26 P <.001). To determine whether these changes produced more equitable access to DDKT, we compared DDKT rates of HS to non-HS candidates (cPRA 0–79%). Post-KAS, cPRA, 98% candidates had an equivalent DDKT rate (aIRR: 0.65 0.94 1.36 , P =.8) to non-HS candidates, whereas 99% candidates had a higher DDKT rate (aIRR: 1.19 1.68 2.38 , P =.02). Although cPRA 99.5–99.9% candidates had an increased DDKT rate (aIRR: 2.46 3.50 4.98 , P <.001) compared to non-HS candidates, cPRA 99.9%+ candidates had a significantly lower DDKT rate (aIRR: 0.29 0.40 0.56 , P <.001). KAS has improved access to DDKT for HS candidates, although substantial imbalance exists between cPRA 99.5–99.9% and 99.9%+ candidates.
KW - clinical research/practice
KW - health services and outcomes research
KW - kidney transplantation/nephrology
KW - organ allocation
KW - organ procurement and allocation
KW - panel-reactive antibody (PRA)
KW - sensitization
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U2 - 10.1111/ajt.15149
DO - 10.1111/ajt.15149
M3 - Article
C2 - 30372592
AN - SCOPUS:85057245525
VL - 19
SP - 1129
EP - 1138
JO - American Journal of Transplantation
JF - American Journal of Transplantation
SN - 1600-6135
IS - 4
ER -