The national landscape of deceased donor kidney transplantation for the highly sensitized: Transplant rates, waitlist mortality, and posttransplant survival under KAS

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...

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Bibliographic Details
Published in:American journal of transplantation 2019-04, Vol.19 (4), p.1129-1138
Main Authors: Jackson, Kyle R., Covarrubias, Karina, Holscher, Courtenay M., Luo, Xun, Chen, Jennifer, Massie, Allan B., Desai, Niraj, Brennan, Daniel C., Segev, Dorry L., Garonzik‐Wang, Jacqueline
Format: Article
Language:English
Subjects:
Adult
Aged
Blood & organ donations
clinical research/practice
Female
health services and outcomes research
Humans
Kidney Failure, Chronic - mortality
Kidney Failure, Chronic - surgery
Kidney Transplantation
kidney transplantation/nephrology
Kidney transplants
Male
Middle Aged
organ allocation
organ procurement and allocation
panel‐reactive antibody (PRA)
Registries
sensitization
Survival Rate
Tissue Donors
Transplants & implants
Waiting Lists
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Summary: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]:1.271.772.46 P = .001, cPRA 99% aIRR:3.184.365.98 P 
ISSN:1600-6135
1600-6143
DOI:10.1111/ajt.15149