Outcomes of cPRA 100% deceased donor kidney transplant recipients under the new Kidney Allocation System: A single-center cohort study

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.

鉴于在肾脏分配系统（KAS）下供体/受体情况组合的变化以及冷缺血时间的增加，有人担心cPRA为100%的受者在KAS下情况可能不佳。我们使用了关于109名cPRA为100%的尸体供肾移植（DDKT）受者的详细的单中心数据，来研究全国登记数据中不易获取的KAS实施后的移植后结果。我们发现3年患者存活率（96.4%）和去除死亡影响的移植物存活率（96.8%）非常高。我们还发现cPRA为100%的受者发生T细胞介导的排斥反应（9.2%）和抗体介导的排斥反应（AMR）（13.8%）的几率相对较低。T细胞介导的排斥反应发作往往相对较轻——50%（5次发作）为1级，50%（5次发作）为2级，没有3级的情况。只有1次发作与移植物丢失有关，但这是在混合排斥的情况下。尽管只有15名受者（13.8%）发生了AMR发作，但其中2次与移植物丢失有关。尽管有排斥反应发作，但绝大多数受者在移植3年后移植物功能良好（血清肌酐中位数为1.5 mg/dL）。总之，cPRA为100%的DDKT受者在KAS下情况良好，尽管应尽一切努力预防AMR以确保长期结果保持良好。