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The following is a summary of “Calibration of Priority Points for Sensitization Status of Kidney Transplant Candidates in the United States,” published in the March 2024 issue of Nephrology by Schold et al.

After 2014, the national organ allocation system underwent a serious change. Using a sliding scale, a deceased donor’s kidney was given based on sensitization (i.e., calculated panel reactive antibody percentage [CRPA%]). The change meant fairer access to transplantation for disadvantaged candidates. 

Researchers started a prospective study to determine whether this new system had made any difference in the U.S.

They used the national scientific registry of transplant recipients to evaluate factors linked to sensitization using multivariable logistic models and deceased donor transplant rates using cumulative incidence and multivariable Cox models.

The result showed a waiting list of 270,912 adults between Jan 2016 and Sept 2023. The six-year incidence of deceased donor transplantation for candidates with cPRA%=[80-85) and [90-95) was 48% and 53%, respectively, compared to 37% for those with cPRA%=[0-20). In multivariable models, candidates with high cPRA% had the highest adjusted hazards for deceased donor transplantation. The association of high cPRA% with transplantation rates varied significantly by region, gender, race/ethnicity, prior dialysis time, and blood type.

Investigators concluded that priority weights need to be readjusted for fair access to transplantation. Additionally, priority points should be accounted for disadvantaged candidate subgroups.

Source: journals.lww.com/cjasn/abstract/9900/calibration_of_priority_points_for_sensitization.366.aspx