Outcomes in the highest panel reactive antibody recipients of deceased donor kidneys under the new kidney allocation system

Abstract

Since the institution of the new kidney allocation system in December 2014, kidney transplant candidates with the highest calculated panel reactive antibodies (cPRA) of 99-100 have been transplanted at much higher rates. However, concerns have been raised that outcomes in these patients might be impaired due to higher immunological risk and longer cold ischemia times resulting from long-distance sharing of kidneys. Here, we compare outcomes at the University of Wisconsin between study patients with cPRA 99-100 and all other recipients of deceased donor kidneys transplanted between 12/04/2014 and 12/31/2015. All patients had at least 6 months post-transplant follow-up. The mean follow-up was 13.9±3 months in cPRA ≥99% and 12.3±3.5 months in cPRA ≤98%. There was a total of 152 transplants, 25 study patients, and 127 controls. No statistically significant differences were found between the two groups in delayed graft function, rejection, kidney function, graft and patient survival, or infections. We conclude that transplanting the most highly sensitized patients with kidneys shared outside their local donation service areas is associated with excellent short-term outcomes that are comparable to controls.

The Association Between Lung Recipient Travel Distance and Posttransplant Survival

“…Considerations are being given to broader geographic sharing of donor allografts to increase patient access in liver, kidney, and heart transplantation. [2][3][4] These considerations may be applicable to lung transplant, but with increased patient access, recipient travel may also increase. The impact of travel distance on postlung transplant graft survival is not fully understood and is the focus of our study.…”

Fatores Associados À Mortalidade Do Paciente Com Traumatismo Cranioencefálico Moderado E Grave Na Unidade De Terapia Intensiva Do Hospital Governador Celso Ramos

“…This decrease may have been induced by immunosuppressive medications, as also described by Souza, 2008. The results for the 6th month indicate that the patients who showed an increase in the PRA percentage (11.65% for class I and 3.88% for class II) require greater attention and closer follow-up in the post-transplant period. According to the study by Lee et al, 2004, these patients are most susceptible to developing acute rejection and to lose the graft, since high PRA levels are associated with rejection processes, incorrect use of immunosuppression, or failure of the transplanted organ to function due to an immediate response of the antibodies (PARAJULI, et al, 2017).…”

Nocardia infection in kidney transplant recipients: A single‐center experience

“…Cytomegalovirus prophylaxis was with valganciclovir for 6 months for donor‐positive/recipient‐negative patients as well as recipient‐positive patients receiving ATG or alemtuzumab. Donor‐negative/recipient‐negative patients received 3 months of acyclovir for the prevention of herpes infections as described before …”