The real unmet need: A multifactorial approach for identifying sensitized kidney candidates with low access to transplant

Background At the start of 2020, the kidney waiting list consisted of 2526 candidates with a calculated panel reactive antibody (CPRA) of 99.9% or greater, a cohort demonstrated in published research to have meaningfully lower than average access to transplantation even under the revised kidney allocation system (KAS). Methods This was a retrospective analysis of US kidney registrations using data from the OPTN [Reference (https://optn.transplant.hrsa.gov/data/about‐data/)]. The period‐prevalent study cohort consisted of US kidney‐alone registrations who waited at least 1 day between April 1, 2016, when HLA DQ‐Alpha and DP‐Beta unacceptable antigen data became available in OPTN data collection, to December 31, 2019. Poisson rate regression was used to model deceased donor kidney transplant rates per active year waiting and using an offset term to account for differential at‐risk periods. Median time to transplant was estimated for each IRR group using the Kaplan–Meier method. Sensitivity analyses were included to address geographic variation in supply‐to‐demand ratios and differences in dialysis time or waiting time. Results In this study, we found 1597 additional sensitized (CPRA 50–