There are many reasons why a patient may be made inactive on the kidney transplant waiting list, including psychosocial or financial issues or medical comorbidities. This has important implications for a patient’s overall morbidity and mortality. Sensitization, as measured by calculated plasma reactive antibodies (cPRA), also affects likelihood of transplant. Recently, a new “Kidney Allocation System” was implemented, the priorities of which were to increase transplant rates in individuals who are highly sensitized and to improve access to underserved populations. In this retrospective cohort study, 42,558 first-time registrants (2014-2016) identified through the Organ Procurement and Transplantation Network kidney transplant database were followed up to determine whether activity status changes differ among races/ethnicities and levels or sensitization, and if these differences are associated with transplant probability after implementation of the Kidney Allocation System. Researchers found that in patients in the calculated plasma reactive antibody categories of 0% to 79% cPRA, there was no significant difference in transplant probability among races/ethnicities. However, with cPRA between 80% and 89%, white race was associated with an increase in transplant probability (HR 1.8, 95% CI 1.4 to 2.2). Similarly, white patients with a cPRA of 90% or greater were more likely to receive transplantation than black individuals with the same cPRA levels (HR 2.4, 95% CI 2.1 to 2.8). Additionally, white individuals were more likely to have the issues that made them inactive resolved, as compared to both Hispanic patients (HR 1.2, 95% CI 1.17 to 1.3) and black patients (HR 1.4, 95% CI 1.3 to 1.4). Investigators therefore concluded that, with the Kidney Allocation System, in highly sensitized populations, black patients continue to have less access to transplant, as compared to white patients. Additionally, both Hispanic and black individuals are less likely to be activated after being made inactive, as compared to white patients.
Click to read the study in JAMA Surgery
Image: PD
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