Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors : The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch
Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved..
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.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:108 |
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| Enthalten in: |
Transplantation - 108(2024), 3 vom: 01. Feb., Seite 787-801 |
| Sprache: |
Englisch |
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Date Completed 23.02.2024 Date Revised 26.02.2024 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1097/TP.0000000000004824 |
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| Förderinstitution / Projekttitel: |
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| 245 | 1 | 0 | |a Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors |b The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch |
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| 500 | |a published: Print-Electronic | ||
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| 520 | |a Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved. | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 520 | |a 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 | ||
| 650 | 4 | |a Journal Article | |
| 650 | 7 | |a Antibodies |2 NLM | |
| 650 | 7 | |a HLA Antigens |2 NLM | |
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| 700 | 1 | |a Fernandez, Constantino |e verfasserin |4 aut | |
| 700 | 1 | |a Muro, Manuel |e verfasserin |4 aut | |
| 700 | 1 | |a Vega, Rocio |e verfasserin |4 aut | |
| 700 | 1 | |a Palou, Eduard |e verfasserin |4 aut | |
| 700 | 1 | |a Ruiz, Juan Carlos |e verfasserin |4 aut | |
| 700 | 1 | |a Diekman, Fritz |e verfasserin |4 aut | |
| 700 | 1 | |a Padilla, Maria |e verfasserin |4 aut | |
| 700 | 1 | |a Mancebo, Esther |e verfasserin |4 aut | |
| 700 | 1 | |a Perez, Isabel |e verfasserin |4 aut | |
| 700 | 1 | |a Andres, Amado |e verfasserin |4 aut | |
| 700 | 1 | |a Ontañon, Jesus |e verfasserin |4 aut | |
| 700 | 1 | |a Dominguez-Gil, Beatriz |e verfasserin |4 aut | |
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| 700 | 1 | |a Andres Belmonte, Amado |e investigator |4 oth | |
| 700 | 1 | |a Franco Maside, Andres |e investigator |4 oth | |
| 700 | 1 | |a Garcia, Anna |e investigator |4 oth | |
| 700 | 1 | |a Alonso Melgar, Angel |e investigator |4 oth | |
| 700 | 1 | |a Orduña Domingo, Antonio |e investigator |4 oth | |
| 700 | 1 | |a Vazquez Araujo, Begoña |e investigator |4 oth | |
| 700 | 1 | |a Diaz Rodriguez, Candido |e investigator |4 oth | |
| 700 | 1 | |a Jimenez Martin, Carlos |e investigator |4 oth | |
| 700 | 1 | |a Vilches Ruiz, Carlos |e investigator |4 oth | |
| 700 | 1 | |a Facundo Molas, Carme |e investigator |4 oth | |
| 700 | 1 | |a Diaz Corte, Carmen |e investigator |4 oth | |
| 700 | 1 | |a Fernandez Rivera, Constantino |e investigator |4 oth | |
| 700 | 1 | |a Moreno Parado, Cristina |e investigator |4 oth | |
| 700 | 1 | |a Abad Molina, Cristina |e investigator |4 oth | |
| 700 | 1 | |a Janeiro, Dario |e investigator |4 oth | |
| 700 | 1 | |a Planelles Silvestre, Dolores |e investigator |4 oth | |
| 700 | 1 | |a Palou Rivera, Eduard |e investigator |4 oth | |
| 700 | 1 | |a Mancebo Sierra, Esther |e investigator |4 oth | |
| 700 | 1 | |a Moreso Mateos, Francesc |e investigator |4 oth | |
| 700 | 1 | |a Garcia Erauzkin, Gorka |e investigator |4 oth | |
| 700 | 1 | |a Lorenzo Gonzalez, Inmaculada |e investigator |4 oth | |
| 700 | 1 | |a Beneyto Castello, Isabel |e investigator |4 oth | |
| 700 | 1 | |a Perez Flores, Isabel |e investigator |4 oth | |
| 700 | 1 | |a Saura Lujan, Isabel |e investigator |4 oth | |
| 700 | 1 | |a Gañan Nieto, Israel |e investigator |4 oth | |
| 700 | 1 | |a Bernardo Gonzalez, Ivan |e investigator |4 oth | |
| 700 | 1 | |a Cid Fernandez, Javier |e investigator |4 oth | |
| 700 | 1 | |a Ontañón Rodríguez, Jesús |e investigator |4 oth | |
| 700 | 1 | |a Martinez Laso, Jorge |e investigator |4 oth | |
| 700 | 1 | |a Gomez Rial, Jose |e investigator |4 oth | |
| 700 | 1 | |a Cruzado Garrit, Josep Maria |e investigator |4 oth | |
| 700 | 1 | |a Ruiz San Millan, Juan Carlos |e investigator |4 oth | |
| 700 | 1 | |a Gimeno Lozano, Juan Jose |e investigator |4 oth | |
| 700 | 1 | |a Kanter Berga, Julia |e investigator |4 oth | |
| 700 | 1 | |a Cañas Sole, Laura |e investigator |4 oth | |
| 700 | 1 | |a Mozo Avellanedo, Lourdes |e investigator |4 oth | |
| 700 | 1 | |a Muro Amador, Manuel |e investigator |4 oth | |
| 700 | 1 | |a Lopez Hoyos, Marcos |e investigator |4 oth | |
| 700 | 1 | |a Gonzalez Diaz, Marcos |e investigator |4 oth | |
| 700 | 1 | |a Valentin Muñoz, Maria Oliva |e investigator |4 oth | |
| 700 | 1 | |a Perez Tamajon, Maria L |e investigator |4 oth | |
| 700 | 1 | |a Crespo Barrio, Marta |e investigator |4 oth | |
| 700 | 1 | |a Artamendi, Marta |e investigator |4 oth | |
| 700 | 1 | |a Fernandez Lucas, Milagros |e investigator |4 oth | |
| 700 | 1 | |a Martinez Pomar, Natalia |e investigator |4 oth | |
| 700 | 1 | |a Olivares Beobide, Nerea |e investigator |4 oth | |
| 700 | 1 | |a Rodriguez Ferrero, Maria Luisa |e investigator |4 oth | |
| 700 | 1 | |a Fraile, Pilar |e investigator |4 oth | |
| 700 | 1 | |a Vega, Rocío |e investigator |4 oth | |
| 700 | 1 | |a Hernandez Gallego, Roman |e investigator |4 oth | |
| 700 | 1 | |a Burillo Sanz, Sergio |e investigator |4 oth | |
| 700 | 1 | |a Cabello Pelegrin, Sheilla |e investigator |4 oth | |
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