{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,7]],"date-time":"2026-09-07T17:52:32Z","timestamp":1788803552819,"version":"build-2803163510"},"reference-count":32,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2019,11,26]],"date-time":"2019-11-26T00:00:00Z","timestamp":1574726400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100006108","name":"National Center for Advancing Translational Sciences","doi-asserted-by":"publisher","award":["KL2TR002379"],"award-info":[{"award-number":["KL2TR002379"]}],"id":[{"id":"10.13039\/100006108","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2019,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>Kidney paired donation (KPD) and the new kidney allocation system (KAS) in the United States have led to improved transplantation rates for highly sensitized candidates. We aimed to assess the potential need for other approaches to improve the transplantation rate of highly sensitized candidates such as desensitization. Using the UNOS STAR file, we analyzed transplant rates in a prevalent active waiting\u2010list cohort as of June 1, 2016, followed for 1\u00a0year. The overall transplantation rate was 18.9% (11\u00a0129\/58769). However, only 9.7% (213\/2204) of candidates with a calculated panel reactive antibody \u226599.9% received a transplant, and highly sensitized candidates were less likely to receive a living donor transplant. Among candidates with a CPRA\u00a0\u2265\u00a099.5% (ie. 100%), only 2.5% of transplants were from living donors (13 total, 7 from KPD). Nearly 4\u00a0years after KAS (6\/30\/2018), 1791 actively wait\u2010listed candidates had a CPRA of \u226599.9% and 34.6% (620\/1791) of these had \u22655\u00a0years of waiting time. Thus, despite KPD and KAS, many sensitized candidates have not been transplanted even with prolonged waiting time. We conclude that candidates with a CPRA\u00a0\u2265\u00a099.9% and sensitized candidates with an incompatible living donor and prolonged waiting time may benefit from desensitization to improve their ability to receive a transplant.<\/jats:p>","DOI":"10.1111\/ctr.13751","type":"journal-article","created":{"date-parts":[[2019,11,5]],"date-time":"2019-11-05T16:50:05Z","timestamp":1572972605000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":88,"title":["Managing highly sensitized renal transplant candidates in the era of kidney paired donation and the new kidney allocation system: Is there still a role for desensitization?"],"prefix":"10.1111","volume":"33","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3274-3277","authenticated-orcid":false,"given":"Carrie A.","family":"Schinstock","sequence":"first","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Internal Medicine Mayo Clinic Rochester MN USA"},{"name":"The William J von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9318-2437","authenticated-orcid":false,"given":"Byron H.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Health Sciences Research Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert A.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"New York University Langone Transplant Institute New York NY USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stanley C.","family":"Jordan","sequence":"additional","affiliation":[{"name":"Cedars Sinai Medical Center Los Angeles CA USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Bentall","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Internal Medicine Mayo Clinic Rochester MN USA"},{"name":"The William J von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic Rochester MN USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Martin","family":"Mai","sequence":"additional","affiliation":[{"name":"Transplant Center Mayo Clinic Jacksonville FL USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hasan A.","family":"Khamash","sequence":"additional","affiliation":[{"name":"Division of Nephrology and Hypertension Department of Internal Medicine Mayo Clinic Phoenix AZ USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1392-0792","authenticated-orcid":false,"given":"Mark D.","family":"Stegall","sequence":"additional","affiliation":[{"name":"The William J von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic Rochester MN USA"},{"name":"Division of Transplantation Surgery Department of 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