The national landscape of deceased donor kidney transplantation for the highly sensitized: Transplant rates, waitlist mortality, and posttransplant survival under KAS

Deceased donor kidney transplantation (DDKT) rates for highly sensitized (HS) candidates increased early after implementation of the Kidney Allocation System (KAS) in 2014. However, this may represent a bolus effect, and a granular investigation of the current state of DDKT for HS candidates remains lacking. We studied 270,722 DDKT candidates from the SRTR from 12/4/2011-12/3/2014 (‘pre-KAS’) and 12/4/2014-12/3/2017 (‘post-KAS’), analyzing DDKT rates for HS candidates using adjusted negative binomial regression. Post-KAS, candidates with the highest levels of sensitization had an increased DDKT rate compared to pre-KAS (cPRA 98% adjusted incidence rate ratio [aIRR]:(1.27)1.77(2.46) p=0.001, cPRA 99% aIRR:(3.18)4.36(5.98) p