L. Rodrigues1, A. Diamond3, A. Di Carlo2, S. Karhadkar2 1Temple University,College Of Science And Technology,Philadelpha, PA, USA 2Temple University Hospital,Surgery,Philadelphia, PA, USA 3Temple University Hospital,Pharmacy,Philadelphia, PA, USA
Introduction:
Highly sensitized (HS) patients experience longer wait times for kidney transplantation despite prioritization by the Kidney Allocation System. DCD kidneys have been shown to decrease wait times for most patient populations. However, the concern for increased rejection during DGF has caused hesitancy in using DCD kidneys in HS patients. In this study we evaluate the outcomes of HS kidney transplant recipients who received a DCD kidney.
Methods:
Kidney transplant recipients who received DCD organs from 2015-2018 were studied using the United Network for Organ Sharing (UNOS) database. Patients were divided into three groups for data analysis; calculated panel-reactive antibody (cPRA) 0% (Group 1), 1-89% (Group 2), and 90-100% (Group 3). Data analysis was performed with the SPSS software. Survival analysis was performed using a Cox regression and Kaplan-Meier model.
Results:
7,854 kidney transplant recipients received DCD kidneys. Patients were divided into three groups: cPRA 0% (n= 4,598), cPRA 1-89% (n= 2,233), and cPRA 90-100% (n= 1,023). There was no significant difference in baseline characteristics. The mean KDPI in Group 3 was lower compared to other groups (51% vs. 50% vs. 44%; p<0.001). Rabbit antithymocyte globulin induction was used for most patients in each group (58% vs. 66% vs. 75%). The incidence of DGF was similar between the 3 groups (41% vs. 42%. vs. 43%; p= 0.45). A higher number of patients in Group 3 were treated for rejection within 12 months (4.2% vs. 4.1% vs. 6.1%; p=0.003). No differences in graft failure (7.1% vs. 7.1 % vs. 6.7%; p=0.905) and patient survival (95% vs. 95% vs. 96%; p=0.449) were noted between groups. A Cox regression model identified KDPI as a significant factor, independent of cPRA, impacting graft survival (OR 3.76; 95% CI: 2.61-5.41).
Conclusion:
DCD kidney transplantation provides HS patients with comparable long term graft survival with an acceptable incidence of treated rejection within 12 months. Notably, KDPI had a larger influence on graft survival than the recipient’s cPRA. This study supports an increased use of DCD kidneys in HS patients.
