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Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors: The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch.
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.
Affiliation
  • Valentin MO; Nephrology Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
  • Crespo M; Nephrology Department, Hospital De Mar, Barcelona, Spain.
  • Fernandez C; Nephrology Department, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
  • Muro M; Immunology Department, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
  • Vega R; Transplant Coordination Department, Organización Nacional de Trasplantes, Madrid, Spain.
  • Palou E; Immunology Department, Hospital Clinic, Barcelona, Spain.
  • Ruiz JC; Nephrology Department, Hospital Universitario Marqués de Valdecilla, University of Cantabria, IDIVAL, Santander, Spain.
  • Diekman F; Nephrology Department, Hospital Clinic, Barcelona, Spain.
  • Padilla M; Immunology Department, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
  • Mancebo E; Immunology Department, Hospital 12 de Octubre, Madrid, Spain.
  • Perez I; Nephrology Department, Hospital Clinico San Carlos, Madrid, Spain.
  • Andres A; Nephrology Department, Hospital 12 de Octubre, Madrid, Spain.
  • Ontañon J; Immunology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
  • Dominguez-Gil B; Immunology Department, Hospital Clinico Universitario Virgen de la Arrixaca, Murcia, Spain.
Transplantation ; 108(3): 787-801, 2024 Mar 01.
Article in En | MEDLINE | ID: mdl-37867239
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.
Subject(s)

Full text: 1 Database: MEDLINE Main subject: Kidney Transplantation Limits: Humans Language: En Year: 2024 Type: Article

Full text: 1 Database: MEDLINE Main subject: Kidney Transplantation Limits: Humans Language: En Year: 2024 Type: Article