Jae-Hyung Chang, Kristen L King, S Ali Husain, Geoffrey K Dube, E Rodica Vasilescu, Shefali Patel, David J Cohen, Lloyd E Ratner, Sumit Mohan, R John Crew
{"title":"Highly Sensitized Kidney Transplant Outcomes After the 2014 Kidney Allocation System Change.","authors":"Jae-Hyung Chang, Kristen L King, S Ali Husain, Geoffrey K Dube, E Rodica Vasilescu, Shefali Patel, David J Cohen, Lloyd E Ratner, Sumit Mohan, R John Crew","doi":"10.1177/15269248241268697","DOIUrl":null,"url":null,"abstract":"<p><p><b>Introduction:</b> Kidney Allocation System (KAS) was implemented by United Network for Organ Sharing in 2014 to reduce allocation disparities. <b>Research Questions:</b> Outcomes of highly sensitized patients (calculated panel reactive antibody (cPRA) ≥ 97%) before and after KAS were compared to low-risk recipients (cPRA <10%) in the post-KAS era were examined. The impact on racial disparities was determined. <b>Design:</b> This was a retrospective study of national registry data. Two cohorts of adult candidates waitlisted for deceased donor transplantation during 3-year periods before and after KAS were identified. <b>Results:</b> Highly sensitized patients (N = 1238 and 4687) received a deceased donor kidney transplant between January 1, 2011 and December 31, 2013 and between January 1, 2015 and December, 31, 2017. Racial disparity for highly sensitized patients improved, yet remained significant (P < 0.001), with Black patients comprising 40% and 41% of the highly sensitized candidates and 28% and 34% of the recipients pre- and post-KAS. While posttransplant death-censored graft failure for highly sensitized recipients was similar overall, post-KAS was associated with improved graft survival in the first year after transplant (HR 0.56, 95% CI 0.40-0.78). When compared to contemporaneous lowrisk recipients, both death-censored and all-cause graft failure were similar for highly sensitized recipients and was associated with increased risk for death-censored graft failure beyond the first year (HR 1.39, 95% CI 1.11-1.73). <b>Conclusion:</b> The allocation system led to an increase in transplantation in highly sensitized candidates without compromising outcomes. Although KAS has led to more balanced transplant rates between highly sensitized Black and White patients, racial inequalities persist.</p>","PeriodicalId":0,"journal":{"name":"","volume":null,"pages":null},"PeriodicalIF":0.0,"publicationDate":"2024-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1177/15269248241268697","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/1 0:00:00","PubModel":"Epub","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
Abstract
Introduction: Kidney Allocation System (KAS) was implemented by United Network for Organ Sharing in 2014 to reduce allocation disparities. Research Questions: Outcomes of highly sensitized patients (calculated panel reactive antibody (cPRA) ≥ 97%) before and after KAS were compared to low-risk recipients (cPRA <10%) in the post-KAS era were examined. The impact on racial disparities was determined. Design: This was a retrospective study of national registry data. Two cohorts of adult candidates waitlisted for deceased donor transplantation during 3-year periods before and after KAS were identified. Results: Highly sensitized patients (N = 1238 and 4687) received a deceased donor kidney transplant between January 1, 2011 and December 31, 2013 and between January 1, 2015 and December, 31, 2017. Racial disparity for highly sensitized patients improved, yet remained significant (P < 0.001), with Black patients comprising 40% and 41% of the highly sensitized candidates and 28% and 34% of the recipients pre- and post-KAS. While posttransplant death-censored graft failure for highly sensitized recipients was similar overall, post-KAS was associated with improved graft survival in the first year after transplant (HR 0.56, 95% CI 0.40-0.78). When compared to contemporaneous lowrisk recipients, both death-censored and all-cause graft failure were similar for highly sensitized recipients and was associated with increased risk for death-censored graft failure beyond the first year (HR 1.39, 95% CI 1.11-1.73). Conclusion: The allocation system led to an increase in transplantation in highly sensitized candidates without compromising outcomes. Although KAS has led to more balanced transplant rates between highly sensitized Black and White patients, racial inequalities persist.
简介器官共享联合网络(United Network for Organ Sharing)于 2014 年实施了肾脏分配系统(Kidney Allocation System,KAS),以减少分配差异。研究问题:将 KAS 实施前后的高敏患者(计算板反应性抗体 (cPRA) ≥ 97%)与低风险受者(cPRA 设计)的结果进行比较:这是一项对国家登记数据的回顾性研究。在 KAS 之前和之后的 3 年期间,确定了两组等待进行死亡供体移植的成人候选者。研究结果2011年1月1日至2013年12月31日和2015年1月1日至2017年12月31日期间,高度敏感患者(N = 1238和4687)接受了死体肾移植。高度敏感患者的种族差异有所改善,但仍很明显(P 结语):分配制度增加了高度致敏患者的移植数量,但不会影响治疗效果。虽然 KAS 使高度致敏的黑人和白人患者的移植率更加均衡,但种族不平等依然存在。