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Outcomes of cPRA 100% deceased donor kidney transplant recipients under the new Kidney Allocation System: A single‐center cohort study
Author(s) -
Jackson Kyle R.,
Chen Jennifer,
Kraus Edward,
Desai Niraj,
Segev Dorry L.,
Alachkar Nada
Publication year - 2020
Publication title -
american journal of transplantation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.89
H-Index - 188
eISSN - 1600-6143
pISSN - 1600-6135
DOI - 10.1111/ajt.15956
Subject(s) - medicine , context (archaeology) , single center , incidence (geometry) , cohort , kidney , creatinine , renal function , kidney transplantation , kidney transplant , transplantation , gastroenterology , paleontology , physics , optics , biology
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.