Korean J Transplant.  2023 Nov;37(Suppl 1):S82. 10.4285/ATW2023.F-6626.

Impact of sensitization and ABO blood types on the opportunity of deceased donor kidney transplantation with prolonged waiting time

• Lee JH
• Yang J
• Seo JH

• KMID: 2551669
• DOI: http://doi.org/10.4285/ATW2023.F-6626

Abstract

The waiting time to deceased donor kidney transplantation (DDKT) is long in Asian countries. We investigated the impact of sensitization and ABO blood type (ABO) on DDKT opportunity using two Korean cohorts: a hospital cohort from two centers and a national database. The impact of panel-reactive antibody (PRA) based on the maximal PRA percentage and ABO on DDKT accessibility was analyzed using a competing risks regression model. In the hospital cohort (n=4,722), 88.2%, 8.7%, and 3.1% of patients belonged to <80%, 80%–99%, and 99% PRA groups, respectively, and 61.1%, 11.6%, and 27.3% belonged to A or B, AB, and O blood types, respectively. When PRA and ABO were combined, PRA <80%/A or B and 80%≤PRA<99%/AB had few-er DDKT opportunities (median, 12 years; subdistribution hazard ratio [sHR], 0.71) compared with PRA <80%/AB (median, 11years). Also, PRA <80%/O, 80%≤PRA<99%/A or B, and PRA99%/AB had a much lower DDKT opportunity (median, 13 years; sHR, 0.49). Furthermore, 80%≤PRA<99%/O and PRA99%/non-AB had the lowest DDKT opportunity (sHR, 0.28). We found similar results in the national cohort (n=18,974). In conclusion, an integrated priority system for PRA and ABO is needed to reduce the inequity in DDKT opportunities, particularly in areas with prolonged waiting times.