Highly Sensitized Kidney Transplant Outcomes After the 2014 Kidney Allocation System Change.
Jae-Hyung Chang, Kristen L King, S Ali Husain and 7 others
PMID 39090844WHAT IT FOUND
The 2014 kidney allocation change was associated with more deceased donor kidney transplants for highly sensitized patients and better first-year graft survival, but long-term death-censored graft failure was similar to before and higher than in low-risk recipients after year one.
Key findings
01For highly sensitized recipients, post-KAS transplant improved death-censored graft survival in the first year (adjusted HR 0.56, 95% CI 0.40-0.78) but not beyond one year (adjusted HR 1.08, 95% CI 0.81-1.45).
02Compared with contemporaneous low-risk recipients after KAS, highly sensitized status was associated with higher death-censored graft failure only beyond the first year (adjusted HR 1.39, 95% CI 1.11-1.73).
03Racial disparity in deceased donor kidney transplantation among highly sensitized patients declined after KAS but remained significant (P < 0.001).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study used retrospective registry data, so associations cannot prove that the policy caused the outcomes, and data entry error, misclassification, and residual confounding are possible. The post-KAS cohort had short follow-up, so longer-term graft outcomes remain uncertain.
Declared interests
The authors declared no potential conflicts of interest.
The easy way to misread this
Do not read the higher post-KAS transplant rate as proof that allocation alone eliminated inequity or guaranteed long-term graft survival: the study was observational, and highly sensitized recipients still had higher death-censored graft failure beyond one year and significant racial disparities remained.