Korean J Transplant.  2023 Nov;37(Suppl 1):S81. 10.4285/ATW2023.F-6622.

Implications of panel-reactive antibody and ABO blood type on graft survival in deceased donor kidney transplantation: proposing a novel allocation scheme

• Lee Jh
• Seo JH
• Yang J

• KMID: 2551668
• DOI: http://doi.org/10.4285/ATW2023.F-6622

Abstract

Background
Waiting time to deceased donor kidney transplantation (DDKT) is very long in Asian countries. Prior research has indicated that the likelihood of transplantation for sensitized patients and those with blood type O is notably diminished, and without the provision of additional allocation points, this inequity remains unresolved. due to the constraints of limited deceased donor kidney availability, considerations of utility are inevitable. As such, our study sought to explore the impact of patient sensitization and ABO blood type on graft failure and patient mortality post-DDKT.
Methods
We analyzed adult, waitlisted patients for DDKT from two Korean cohorts: the hospital cohort from two centers and the national database. The patients were classified into two groups based on the maximal panel-reactive antibody (PRA) percentage; <80%, and ≥80% in hospital cohort and two groups according to PRA positivity in both hospital and national cohort. To examine the impact of PRA and ABO blood types on DDKT opportunity and graft failure, a competing risk regression model was used. Additionally, a time-dependent Cox regression model was used to examine the impact of PRA and ABO blood types on patient mortality of DDKT candidates and recipients.
Results
Among 4,722 waitlisted patients in the hospital cohort, 474 (10.0%), 2,611 (55.3%), 1,404 (29.7%), and 234 (5.0%) patients belonged to category A and 315 (6.7%), 2,049 (43.4%), 1,900 (40.2%), and 458 (9.7%) patients belonged to category B. In the national cohort (n=16,410), 1,167 (7.1%), 6,967 (42.5%), 6,465 (39.4%), and 1,811 (11.0%) patients belonged to category B. Prior findings indicate significant disparities in the opportunities for DDKT based on both PRA and ABO blood types.
Conclusions
Our analysis revealed no significant differences in utility outcomes within these cohorts. we propose a novel ap-proach to organ allocation that involves distributing additional points based on the inverse of DDKT opportunities for groups.