Outcomes of cPRA 100% deceased donor kidney transplant recipients under the new Kidney Allocation System: a single-center cohort study.

In light of changes in donor/recipient case-mix and increased cold ischemia times under KAS, there is some concern that cPRA 100% recipients might be doing poorly under KAS. We used granular, single-center data on 109 cPRA 100% deceased donor kidney transplant (DDKT) recipients to study post-KAS post-transplant outcomes not readily available in national registry data. We found that three-year patient (96.4%) and death-censored graft survival (96.8%) was excellent. We also found that cPRA 100% recipients had a relatively low incidence of T-cell mediated rejection (TCMR) (17.4%) and antibody mediated rejection (AMR) (13.8%). TCMR episodes tended to be relatively mild - 52.4% (11 episodes) were borderline, 26.3% (5 episodes) were grade 2, and none were grade 3. Only one episode was associated with graft loss, but this was in the context of a mixed rejection. Although only 15 recipients (13.8%) developed an AMR episode, two of these were associated with a graft loss. Despite the rejection episodes, the vast majority of recipients had excellent graft function three years post-transplant (median serum creatinine 1.5 mg/dL). In conclusion, cPRA 100% DDKT recipients are doing well under KAS, although every effort should be made to prevent AMR to ensure long-term outcomes remain excellent.