학술논문
Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors: The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch
Document Type
Academic Journal
Author
Valentin, Maria O.; Crespo, Marta; Fernandez, Constantino; Muro, Manuel; Vega, Rocio; Palou, Eduard; Ruiz, Juan Carlos; Diekman, Fritz; Padilla, Maria; Mancebo, Esther; Perez, Isabel; Andres, Amado; Ontañon, Jesus; Dominguez-Gil, Beatriz; Gutierrez Dalmau, Alex; Andres Belmonte, Amado; Franco Maside, Andres; Garcia, Anna; Alonso Melgar, Angel; Orduña Domingo, Antonio; Vazquez Araujo, Begoña; Diaz Rodriguez, Candido; Jimenez Martin, Carlos; Vilches Ruiz, Carlos; Facundo Molas, Carme; Diaz Corte, Carmen; Fernandez Rivera, Constantino; Moreno Parado, Cristina; Abad Molina, Cristina; Janeiro, Dario; Planelles Silvestre, Dolores; Palou Rivera, Eduard; Mancebo Sierra, Esther; Moreso Mateos, Francesc; Garcia Erauzkin, Gorka; Lorenzo Gonzalez, Inmaculada; Beneyto Castello, Isabel; Perez Flores, Isabel; Saura Lujan, Isabel; Gañan Nieto, Israel; Bernardo Gonzalez, Ivan; Cid Fernandez, Javier; Ontañón Rodríguez, Jesús; Martinez Laso, Jorge; Gomez Rial, Jose; Cruzado Garrit, Josep Maria; Ruiz San Millan, Juan Carlos; Gimeno Lozano, Juan Jose; Kanter Berga, Julia; Cañas Sole, Laura; Mozo Avellanedo, Lourdes; Muro Amador, Manuel; Lopez Hoyos, Marcos; Gonzalez Diaz, Marcos; Valentin Muñoz, Maria Oliva; Perez Tamajon, Maria L; Crespo Barrio, Marta; Artamendi, Marta; Fernandez Lucas, Milagros; Martinez Pomar, Natalia; Olivares Beobide, Nerea; Rodriguez Ferrero, Maria Luisa; Fraile, Pilar; Vega, Rocío; Hernandez Gallego, Roman; Burillo Sanz, Sergio; Cabello Pelegrin, Sheilla
Source
Transplantation. Mar 01, 2024 108(3):787-801
Subject
Language
English
ISSN
0041-1337
Abstract
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.