Scientific publications

Improving the Access of Highly Sensitized Patients to Kidney Transplantation From Deceased Donors: The Spanish PATHI Program With Allocation Based on the Virtual Crossmatch

Oct 23, 2023 | Magazine: Transplantation

Maria O Valentin  1 , Marta Crespo  2 , Constantino Fernandez  3 , Manuel Muro  4 , Rocio Vega  5 , Eduard Palou  6 , Juan Carlos Ruiz  1 , Fritz Diekman  7 , Maria Padilla  4 , Esther Mancebo  8 , Isabel Perez  9 , Amado Andres  10 , Jesus Ontañon  11 , Beatriz Dominguez-Gil  4 ; Working Group PATHI

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.

CITATION  Transplantation. 2023 Oct 23.  doi: 10.1097/TP.0000000000004824