Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA)
Autor(a) principal: | |
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Data de Publicação: | 2016 |
Outros Autores: | , , , , , , , |
Tipo de documento: | Artigo |
Idioma: | eng |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000300002 |
Resumo: | Introduction: Kidney transplant improves survival even in highly-sensitized(HS) patients. To overcome their disadvantage in accessing transplantation, those with high Complement Dependent Cytotoxic PRA (CDC-PRA) receive additional points during allocation. Whether this strategy reaches all HS patients and how long they wait for a transplant is largely undetermined. Methods: Patients on our units active wait-list for kidney transplantation in the year 2014 were analyzed. CDC-PRA and calculated PRA (cPRA) were recorded. To obtain cPRA, antibodies in the last serum available specific for HLA-A,-B or -DR with an intensity > 1000 MFI were considered. Results: The cPRA values in the population (N=551) were 0% (N=312), 1-79% (N=118) and ≥ 80% (22%; N=121). Among these groups, the proportion of women (29.5, 55.9 and 61.2%, P<0.001), prior sensitizing events (43.3, 80.5 and 96.7%, P<0.001) and time on dialysis (median of 3.9, 4.1 and 6.0 years, P<0.001) increased with cPRA, respectively. In most of those with a cPRA ≥ 80%, the CDC-PRA raised no suspicion of HS status (median 0%, P25-75 0-8%) and only 35 (28.9%) or 12 patients (9.9%) had a CDC-PRA in the peak serum higher than 50 or 80%, respectively (cut-offs needed to obtain additional points during allocation). HS patients by cPRA corresponded to 71% vs 15% of patients waiting for ≥ or <8 years, respectively (P<0.001). Even after exclusion of patients with a CDC-PRA above 50%, this disproportionate representation remained (58% versus 13%, P<0.001). Conclusion: HS patients as measured by cPRA remained longer on the wait-list, both in the primary analysis and when excluding those with a CDC-PRA> 50%. Moreover, only 30% of HS by cPRA patients received the extra points designed to improve their transplantability. We consider that both CDC-PRA and cPRA should be taken into account when defining HS status |
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Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
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7160 |
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Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA)Allocation algorithmCalculated PRACytotoxic PRAHighly sensitized patientsKidney transplantWaiting timeIntroduction: Kidney transplant improves survival even in highly-sensitized(HS) patients. To overcome their disadvantage in accessing transplantation, those with high Complement Dependent Cytotoxic PRA (CDC-PRA) receive additional points during allocation. Whether this strategy reaches all HS patients and how long they wait for a transplant is largely undetermined. Methods: Patients on our units active wait-list for kidney transplantation in the year 2014 were analyzed. CDC-PRA and calculated PRA (cPRA) were recorded. To obtain cPRA, antibodies in the last serum available specific for HLA-A,-B or -DR with an intensity > 1000 MFI were considered. Results: The cPRA values in the population (N=551) were 0% (N=312), 1-79% (N=118) and ≥ 80% (22%; N=121). Among these groups, the proportion of women (29.5, 55.9 and 61.2%, P<0.001), prior sensitizing events (43.3, 80.5 and 96.7%, P<0.001) and time on dialysis (median of 3.9, 4.1 and 6.0 years, P<0.001) increased with cPRA, respectively. In most of those with a cPRA ≥ 80%, the CDC-PRA raised no suspicion of HS status (median 0%, P25-75 0-8%) and only 35 (28.9%) or 12 patients (9.9%) had a CDC-PRA in the peak serum higher than 50 or 80%, respectively (cut-offs needed to obtain additional points during allocation). HS patients by cPRA corresponded to 71% vs 15% of patients waiting for ≥ or <8 years, respectively (P<0.001). Even after exclusion of patients with a CDC-PRA above 50%, this disproportionate representation remained (58% versus 13%, P<0.001). Conclusion: HS patients as measured by cPRA remained longer on the wait-list, both in the primary analysis and when excluding those with a CDC-PRA> 50%. Moreover, only 30% of HS by cPRA patients received the extra points designed to improve their transplantability. We consider that both CDC-PRA and cPRA should be taken into account when defining HS statusSociedade Portuguesa de Nefrologia2016-09-01info:eu-repo/semantics/publishedVersioninfo:eu-repo/semantics/articletext/htmlhttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000300002Portuguese Journal of Nephrology & Hypertension v.30 n.3 2016reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPenghttp://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000300002Magriço,RitaMalheiro,JorgeTafulo,SandraPedroso,SofiaAlmeida,Manuela,La SaleteDias,LeonídioCastro-Henriques,AntónioCabrita,Antónioinfo:eu-repo/semantics/openAccess2024-02-06T17:04:53Zoai:scielo:S0872-01692016000300002Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-20T02:18:56.960713Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) |
title |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) |
spellingShingle |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) Magriço,Rita Allocation algorithm Calculated PRA Cytotoxic PRA Highly sensitized patients Kidney transplant Waiting time |
title_short |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) |
title_full |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) |
title_fullStr |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) |
title_full_unstemmed |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) |
title_sort |
Implications for patients waiting for a kidney transplant of using the calculated panel reactive antibody (cPRA) |
author |
Magriço,Rita |
author_facet |
Magriço,Rita Malheiro,Jorge Tafulo,Sandra Pedroso,Sofia Almeida,Manuela ,La Salete Dias,Leonídio Castro-Henriques,António Cabrita,António |
author_role |
author |
author2 |
Malheiro,Jorge Tafulo,Sandra Pedroso,Sofia Almeida,Manuela ,La Salete Dias,Leonídio Castro-Henriques,António Cabrita,António |
author2_role |
author author author author author author author author |
dc.contributor.author.fl_str_mv |
Magriço,Rita Malheiro,Jorge Tafulo,Sandra Pedroso,Sofia Almeida,Manuela ,La Salete Dias,Leonídio Castro-Henriques,António Cabrita,António |
dc.subject.por.fl_str_mv |
Allocation algorithm Calculated PRA Cytotoxic PRA Highly sensitized patients Kidney transplant Waiting time |
topic |
Allocation algorithm Calculated PRA Cytotoxic PRA Highly sensitized patients Kidney transplant Waiting time |
description |
Introduction: Kidney transplant improves survival even in highly-sensitized(HS) patients. To overcome their disadvantage in accessing transplantation, those with high Complement Dependent Cytotoxic PRA (CDC-PRA) receive additional points during allocation. Whether this strategy reaches all HS patients and how long they wait for a transplant is largely undetermined. Methods: Patients on our units active wait-list for kidney transplantation in the year 2014 were analyzed. CDC-PRA and calculated PRA (cPRA) were recorded. To obtain cPRA, antibodies in the last serum available specific for HLA-A,-B or -DR with an intensity > 1000 MFI were considered. Results: The cPRA values in the population (N=551) were 0% (N=312), 1-79% (N=118) and ≥ 80% (22%; N=121). Among these groups, the proportion of women (29.5, 55.9 and 61.2%, P<0.001), prior sensitizing events (43.3, 80.5 and 96.7%, P<0.001) and time on dialysis (median of 3.9, 4.1 and 6.0 years, P<0.001) increased with cPRA, respectively. In most of those with a cPRA ≥ 80%, the CDC-PRA raised no suspicion of HS status (median 0%, P25-75 0-8%) and only 35 (28.9%) or 12 patients (9.9%) had a CDC-PRA in the peak serum higher than 50 or 80%, respectively (cut-offs needed to obtain additional points during allocation). HS patients by cPRA corresponded to 71% vs 15% of patients waiting for ≥ or <8 years, respectively (P<0.001). Even after exclusion of patients with a CDC-PRA above 50%, this disproportionate representation remained (58% versus 13%, P<0.001). Conclusion: HS patients as measured by cPRA remained longer on the wait-list, both in the primary analysis and when excluding those with a CDC-PRA> 50%. Moreover, only 30% of HS by cPRA patients received the extra points designed to improve their transplantability. We consider that both CDC-PRA and cPRA should be taken into account when defining HS status |
publishDate |
2016 |
dc.date.none.fl_str_mv |
2016-09-01 |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
dc.type.driver.fl_str_mv |
info:eu-repo/semantics/article |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000300002 |
url |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000300002 |
dc.language.iso.fl_str_mv |
eng |
language |
eng |
dc.relation.none.fl_str_mv |
http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692016000300002 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
text/html |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Nefrologia |
dc.source.none.fl_str_mv |
Portuguese Journal of Nephrology & Hypertension v.30 n.3 2016 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
repository.mail.fl_str_mv |
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1799137279617269760 |