ABO-adjusted calculated panel reactive antibody (cPRA): A unified metric for immunologic compatibility in kidney transplantation

Loren Gragert; Matthew Kadatz; James Alcorn; Darren Stewart; Doris Chang; Jagbir Gill; Robert Liwski; Howard M. Gebel; John Gill; James H. Lan

doi:10.1111/ajt.17175

ABO-adjusted calculated panel reactive antibody (cPRA): A unified metric for immunologic compatibility in kidney transplantation

Loren Gragert, Matthew Kadatz, James Alcorn, Darren Stewart, Doris Chang, Jagbir Gill, Robert Liwski, Howard M. Gebel, John Gill, James H. Lan

Medicine

Producción científica: Contribución a una revista › Artículo › revisión exhaustiva

8 Citas (Scopus)

Resumen

Implementation of the kidney allocation system in 2014 greatly reduced access disparity due to human leukocyte antigen (HLA) sensitization. To address persistent disparity related to candidate ABO blood groups, herein we propose a novel metric termed “ABO-adjusted cPRA,” which simultaneously considers the impact of candidate HLA and ABO sensitization on the same scale. An ethnic-weighted ABO-adjusted cPRA value was computed for 190 467 candidates on the kidney waitlist by combining candidate's conventional HLA cPRA with the remaining fraction of HLA-compatible donors that are ABO-incompatible. Consideration of ABO sensitization resulted in higher ABO-adjusted cPRA relative to conventional cPRA by HLA alone, except for AB candidates since they are not ABO-sensitized. Within cPRA Point Group = 99%, 43% of the candidates moved up to ABO-adjusted cPRA Point Group = 100%, though this proportion varied substantially by candidate blood group. Nearly all O and most B candidates would have elevated ABO-adjusted cPRA values above this policy threshold for allocation priority, but relatively few A candidates displayed this shift. Overall, ABO-adjusted cPRA more accurately measures the proportion of immune-compatible donors compared with conventional HLA cPRA, especially for highly sensitized candidates. Implementation of this novel metric could enable the development of allocation policies permitting more ABO-compatible transplants without compromising equity.

Idioma original	English
Publicación	American Journal of Transplantation
DOI	https://doi.org/10.1111/ajt.17175
Estado	Accepted/In press - 2022

Nota bibliográfica

Funding Information:
NIAID 1U01AI152960‐01 “MHC and KIR Sequencing and Association Analyses in the iGeneTRAiN Studies.” This work was made possible by a Scholarly Retreat at Tulane's A Studio in the Woods. JHL is supported by a Michael Smith Foundation for Health Scholar award. MK is supported by a Michael Smith Health Professional Investigator award. This analysis was based on OPTN data as of March 13, 2022. This work was supported in part by Health Resources and Services Administration contract HHSH250‐2019‐00001C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government.

Publisher Copyright:
© 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

ASJC Scopus Subject Areas

Immunology and Allergy
Transplantation
Pharmacology (medical)

PubMed: MeSH publication types

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

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title = "ABO-adjusted calculated panel reactive antibody (cPRA): A unified metric for immunologic compatibility in kidney transplantation",

abstract = "Implementation of the kidney allocation system in 2014 greatly reduced access disparity due to human leukocyte antigen (HLA) sensitization. To address persistent disparity related to candidate ABO blood groups, herein we propose a novel metric termed “ABO-adjusted cPRA,” which simultaneously considers the impact of candidate HLA and ABO sensitization on the same scale. An ethnic-weighted ABO-adjusted cPRA value was computed for 190 467 candidates on the kidney waitlist by combining candidate's conventional HLA cPRA with the remaining fraction of HLA-compatible donors that are ABO-incompatible. Consideration of ABO sensitization resulted in higher ABO-adjusted cPRA relative to conventional cPRA by HLA alone, except for AB candidates since they are not ABO-sensitized. Within cPRA Point Group = 99%, 43% of the candidates moved up to ABO-adjusted cPRA Point Group = 100%, though this proportion varied substantially by candidate blood group. Nearly all O and most B candidates would have elevated ABO-adjusted cPRA values above this policy threshold for allocation priority, but relatively few A candidates displayed this shift. Overall, ABO-adjusted cPRA more accurately measures the proportion of immune-compatible donors compared with conventional HLA cPRA, especially for highly sensitized candidates. Implementation of this novel metric could enable the development of allocation policies permitting more ABO-compatible transplants without compromising equity.",

author = "Loren Gragert and Matthew Kadatz and James Alcorn and Darren Stewart and Doris Chang and Jagbir Gill and Robert Liwski and Gebel, {Howard M.} and John Gill and Lan, {James H.}",

note = "Funding Information: NIAID 1U01AI152960‐01 “MHC and KIR Sequencing and Association Analyses in the iGeneTRAiN Studies.” This work was made possible by a Scholarly Retreat at Tulane's A Studio in the Woods. JHL is supported by a Michael Smith Foundation for Health Scholar award. MK is supported by a Michael Smith Health Professional Investigator award. This analysis was based on OPTN data as of March 13, 2022. This work was supported in part by Health Resources and Services Administration contract HHSH250‐2019‐00001C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. Publisher Copyright: {\textcopyright} 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.",

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doi = "10.1111/ajt.17175",

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T2 - A unified metric for immunologic compatibility in kidney transplantation

AU - Gragert, Loren

AU - Kadatz, Matthew

AU - Alcorn, James

AU - Stewart, Darren

AU - Chang, Doris

AU - Gill, Jagbir

AU - Liwski, Robert

AU - Gebel, Howard M.

AU - Gill, John

AU - Lan, James H.

N1 - Funding Information: NIAID 1U01AI152960‐01 “MHC and KIR Sequencing and Association Analyses in the iGeneTRAiN Studies.” This work was made possible by a Scholarly Retreat at Tulane's A Studio in the Woods. JHL is supported by a Michael Smith Foundation for Health Scholar award. MK is supported by a Michael Smith Health Professional Investigator award. This analysis was based on OPTN data as of March 13, 2022. This work was supported in part by Health Resources and Services Administration contract HHSH250‐2019‐00001C. The content is the responsibility of the authors alone and does not necessarily reflect the views or policies of the Department of Health and Human Services nor does mention of trade names, commercial products, or organizations imply endorsement by the US Government. Publisher Copyright: © 2022 The Authors. American Journal of Transplantation published by Wiley Periodicals LLC on behalf of The American Society of Transplantation and the American Society of Transplant Surgeons.

PY - 2022

Y1 - 2022

N2 - Implementation of the kidney allocation system in 2014 greatly reduced access disparity due to human leukocyte antigen (HLA) sensitization. To address persistent disparity related to candidate ABO blood groups, herein we propose a novel metric termed “ABO-adjusted cPRA,” which simultaneously considers the impact of candidate HLA and ABO sensitization on the same scale. An ethnic-weighted ABO-adjusted cPRA value was computed for 190 467 candidates on the kidney waitlist by combining candidate's conventional HLA cPRA with the remaining fraction of HLA-compatible donors that are ABO-incompatible. Consideration of ABO sensitization resulted in higher ABO-adjusted cPRA relative to conventional cPRA by HLA alone, except for AB candidates since they are not ABO-sensitized. Within cPRA Point Group = 99%, 43% of the candidates moved up to ABO-adjusted cPRA Point Group = 100%, though this proportion varied substantially by candidate blood group. Nearly all O and most B candidates would have elevated ABO-adjusted cPRA values above this policy threshold for allocation priority, but relatively few A candidates displayed this shift. Overall, ABO-adjusted cPRA more accurately measures the proportion of immune-compatible donors compared with conventional HLA cPRA, especially for highly sensitized candidates. Implementation of this novel metric could enable the development of allocation policies permitting more ABO-compatible transplants without compromising equity.

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ABO-adjusted calculated panel reactive antibody (cPRA): A unified metric for immunologic compatibility in kidney transplantation

Resumen

Nota bibliográfica

ASJC Scopus Subject Areas

PubMed: MeSH publication types

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