Disparity in the access to kidney transplantation for sensitized patients in the state of Sao Paulo-Brazil

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dc.contributor.authorPerosa, Marcelo
dc.contributor.authorFerreira, Gustavo F.
dc.contributor.authorModelli, Luis G. [UNESP]
dc.contributor.authorMedeiros, Marizete P.
dc.contributor.authorNeto, Soraia R.
dc.contributor.authorMoreira, Frederico
dc.contributor.authorZampieri, Fernando G.
dc.contributor.authorde Marco, Renato
dc.contributor.authorBortoluzzo, Adriana B.
dc.contributor.authorVenezuela, Maria K.
dc.contributor.institutionKidney-Pancreas Transplantation Service of Leforte and Oswaldo Cruz Hospitals
dc.contributor.institutionSanta Casa Juiz de Fora
dc.contributor.institutionUniversidade Estadual Paulista (UNESP)
dc.contributor.institutionSao Paulo Organ Allocation System
dc.contributor.institutionOswaldo Cruz Hospital
dc.contributor.institutionImmunogenetic Institute and Research Incentive Funding Association
dc.contributor.institutionStatistics and Data Science
dc.date.accessioned2022-04-28T19:42:50Z
dc.date.available2022-04-28T19:42:50Z
dc.date.issued2021-10-01
dc.description.abstractHighly sensitized (HS) patients accumulate on deceased donor kidney transplantation (DDKT) waitlists worldwide due to matching difficulty and inequity of allocation policies. Current situation of HS patients on KT waitlist in Brazil has not been published. All patients enrolled on the KT waitlist of the State of São Paulo from 2002 to 2017 were retrospectively assessed. Patients were divided into eight groups according to their degree of sensitization, PRA of 0%, >0–40%, >40–80%, >80–85%, >85–90%, >90–95%, >95–98% and > 98%. Cumulative incidence curves for transplantation or mortality/removal from waitlist were estimated by competing risk. Among 50,249 waitlisted candidates, 1247 prioritized, 2467 with age < 18 or > 75 years and 4152 submitted to living-donor KT were excluded from the analysis, remaining 42,383 patients. There were 29,664(70%) PRA 0%, 5611(13.2%) PRA > 0–40%, 3442(8.2%) PRA > 40–80%, 507(1.2%) PRA > 80–85%, 564(1.3%) PRA > 85–90%, 825(1.9%) PRA >90–95%, 859(2%) PRA > 95–98% and 911(2.2%) PRA > 98%. There was a progressive increase in the need of prioritization, waiting time for KT or on waitlist and time on dialysis as PRA increased (p < 0.001). Probability of DDKT clearly increased as PRA decreased so that PRA 0% candidates were much more likely to be transplanted compared to PRA > 98% patients(HR:13.02, p < 0.001). Waiting list mortality/removal was higher among PRA > 0–40%(HR1.05,p = 0.03), PRA > 90–95%(HR:1.10,p = 0.05), PRA > 95–98%(HR:1.26,p < 0.001) and PRA > 98%(HR:1.09,p = 0.05) patients compared to PRA zero candidates. HS patients in Sao Paulo-Brazil required greater prioritization due to lack of venous access, longer dialysis and waitlist times, lower probability of DDKT and higher rates of waitlist mortality/removal. We confirmed the disparity of access to KT among HS patients in Sao Paulo-Brazil, indicating the need of new strategies that optimize transplantation for this subcategory of patients.en
dc.description.affiliationKidney-Pancreas Transplantation Service of Leforte and Oswaldo Cruz Hospitals
dc.description.affiliationKidney Transplantation Service Santa Casa Juiz de Fora
dc.description.affiliationKidney Transplantation Service UNESP
dc.description.affiliationSao Paulo Organ Allocation System
dc.description.affiliationStatistics and Research Department Oswaldo Cruz Hospital
dc.description.affiliationImmunogenetic Institute and Research Incentive Funding Association
dc.description.affiliationInsper Institute of Education and Research Statistics and Data Science
dc.description.affiliationUnespKidney Transplantation Service UNESP
dc.identifierhttp://dx.doi.org/10.1016/j.trim.2021.101441
dc.identifier.citationTransplant Immunology, v. 68.
dc.identifier.doi10.1016/j.trim.2021.101441
dc.identifier.issn1878-5492
dc.identifier.issn0966-3274
dc.identifier.scopus2-s2.0-85112369428
dc.identifier.urihttp://hdl.handle.net/11449/222188
dc.language.isoeng
dc.relation.ispartofTransplant Immunology
dc.sourceScopus
dc.subjectHighly sensitized
dc.subjectKidney transplantation
dc.subjectSensitization
dc.subjectTransplantation
dc.subjectWaiting list
dc.titleDisparity in the access to kidney transplantation for sensitized patients in the state of Sao Paulo-Brazilen
dc.typeArtigo

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