Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors: The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch

被引:7
|
作者
Valentin, Maria O. [1 ,12 ]
Crespo, Marta [2 ]
Fernandez, Constantino [3 ]
Muro, Manuel [4 ]
Vega, Rocio [5 ]
Palou, Eduard [6 ]
Ruiz, Juan Carlos [1 ]
Diekman, Fritz [7 ]
Padilla, Maria [4 ]
Mancebo, Esther [8 ]
Perez, Isabel [9 ]
Andres, Amado [10 ]
Ontanon, Jesus [11 ]
Dominguez-Gil, Beatriz [4 ]
机构
[1] Univ Cantabria, Hosp Univ Marques Valdecilla, Nephrol Dept, IDIVAL, Santander, Spain
[2] Hosp Mar, Nephrol Dept, Barcelona, Spain
[3] Complejo Hosp Univ A Coruna, Nephrol Dept, La Coruna, Spain
[4] Hosp Clin Univ Virgen Arrixaca, Immunol Dept, Murcia, Spain
[5] Transplant Coordinat Dept, Org Nacl Trasplantes, Madrid, Spain
[6] Hosp Clin Barcelona, Immunol Dept, Barcelona, Spain
[7] Hosp Clin Barcelona, Nephrol Dept, Barcelona, Spain
[8] Hosp 12 Octubre, Immunol Dept, Madrid, Spain
[9] Hosp Clin San Carlos, Nephrol Dept, Madrid, Spain
[10] Hosp 12 Octubre, Nephrol Dept, Madrid, Spain
[11] Complejo Hosp Univ Albacete, Immunol Dept, Albacete, Spain
[12] Hosp Univ Marques Valdecilla, Nephrol Dept, Av Valdecilla,S-N, Santander 39008, Spain
关键词
HLA ANTIBODIES; WAITING TIME; REJECTION; SPAIN; RISK;
D O I
10.1097/TP.0000000000004824
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
Background. In 2015, the Spanish National Transplant Organization developed a prioritization system (Program for Access to Transplantation for Highly Sensitized Patients [PATHI]) to increase transplant options for patients with calculated panel-reactive antibodies (cPRAs) >= 98%, based on virtual crossmatch. We describe the experience with the implementation of PATHI and assess its efficacy. Methods. PATHI registry was used to collect characteristics of donors and patients between June 15, 2015, and March 1, 2018. One-year graft and patient survival and acute rejection were also measured. A Cox model was used to identify factors related to patient death and graft loss and logistical regression for those associated with rejection. Results. One thousand eighty-nine patients were included, and 272 (25%) were transplanted. Transplant rate by cPRA was 54.9%, 40.5%, and 12.8% in patients with cPRA98%, cPRA99%, and cPRA100%, respectively. One-year patient survival was 92.5%. Recipient age >= 60, time under dialysis >7 y, and delayed graft function were mortality risk factors. One-year graft survival was 88.7%. The factor related to graft loss was delayed graft function. The rejection rate was 22%. Factors related to rejection were sex, older recipients, and posttransplant donor-specific antibodies. Conclusions. A prioritization approach increases transplant options for highly sensitized patients with appropriate short-term postransplant outcomes. Along with other programs, PATHI may inspire other countries to adopt strategies to meet transplant needs of these patients.
引用
收藏
页码:787 / 801
页数:15
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