{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,28]],"date-time":"2026-07-28T14:14:44Z","timestamp":1785248084487,"version":"3.55.0"},"reference-count":34,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2023,3,13]],"date-time":"2023-03-13T00:00:00Z","timestamp":1678665600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Clinical Transplantation"],"published-print":{"date-parts":[[2023,5]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>At the start of 2020, the kidney waiting list consisted of 2526 candidates with a calculated panel reactive antibody (CPRA) of 99.9% or greater, a cohort demonstrated in published research to have meaningfully lower than average access to transplantation even under the revised kidney allocation system (KAS).<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This was a retrospective analysis of US kidney registrations using data from the OPTN [Reference (https:\/\/optn.transplant.hrsa.gov\/data\/about\u2010data\/)]. The period\u2010prevalent study cohort consisted of US kidney\u2010alone registrations who waited at least 1 day between April 1, 2016, when HLA DQ\u2010Alpha and DP\u2010Beta unacceptable antigen data became available in OPTN data collection, to December 31, 2019. Poisson rate regression was used to model deceased donor kidney transplant rates per active year waiting and using an offset term to account for differential at\u2010risk periods. Median time to transplant was estimated for each IRR group using the Kaplan\u2013Meier method. Sensitivity analyses were included to address geographic variation in supply\u2010to\u2010demand ratios and differences in dialysis time or waiting time.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In this study, we found 1597 additional sensitized (CPRA 50\u2013&lt;99.9%) candidates with meaningfully lower than average access to transplant when simultaneously taking into account CPRA and other factors. In combination with CPRA, candidate blood type, Estimated Post\u2010Transplant Survival Score (EPTS), and presence of other antibody specificities beyond those in the current, 5\u2010locus CPRA were found to influence the likelihood of transplant.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>In total, this suggests approximately 4100 sensitized candidates are on the waiting list who represent a community of disadvantaged patients who may benefit from progressive therapies and interventions to facilitate incompatible transplantation. Though associated with higher risks, such interventions may nevertheless be more attractive than remaining on dialysis with the associated accumulation of mortality risk over time.<\/jats:p><\/jats:sec>","DOI":"10.1111\/ctr.14946","type":"journal-article","created":{"date-parts":[[2023,2,26]],"date-time":"2023-02-26T09:38:15Z","timestamp":1677404295000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":7,"title":["The real unmet need: A multifactorial approach for identifying sensitized kidney candidates with low access to transplant"],"prefix":"10.1111","volume":"37","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9633-1247","authenticated-orcid":false,"given":"Angela Q.","family":"Maldonado","sequence":"first","affiliation":[{"name":"Hansa Biopharma AB  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keighly","family":"Bradbrook","sequence":"additional","affiliation":[{"name":"United Network for Organ Sharing  Richmond Virginia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristoffer","family":"Sj\u00f6holm","sequence":"additional","affiliation":[{"name":"Hansa Biopharma AB  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"Kjellman","sequence":"additional","affiliation":[{"name":"Hansa Biopharma AB  Lund Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9709-8918","authenticated-orcid":false,"given":"Joshua","family":"Lee","sequence":"additional","affiliation":[{"name":"Immucor  Norcross Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Darren","family":"Stewart","sequence":"additional","affiliation":[{"name":"United Network for Organ Sharing  Richmond Virginia USA"},{"name":"NYU Langone Transplant Institute  New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,3,13]]},"reference":[{"key":"e_1_2_8_2_1","unstructured":"Guidance for Industry Expedited Programs for Serious Conditions \u2013 Drugs and Biologics OMB Control No. 0910\u20100765]. Accessed 4\/1\/2022. Expedited Programs for Serious Conditions\u2013Drugs and Biologics | FDA."},{"key":"e_1_2_8_3_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jval.2019.07.007"},{"key":"e_1_2_8_4_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.suc.2013.08.007"},{"key":"e_1_2_8_5_1","first-page":"1129","article-title":"The national landscape of deceased donor kidney transplantation for the highly sensitized: transplant rates, waitlist mortality, and posttransplant survival under KAS","volume":"4","author":"Jackson KR","year":"2018","journal-title":"Am J Transplant"},{"key":"e_1_2_8_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/ctr.13751"},{"key":"e_1_2_8_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15825"},{"key":"e_1_2_8_8_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2016.1625"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.21926\/obm.transplant.2102143"},{"key":"e_1_2_8_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.14922"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwh090"},{"key":"e_1_2_8_12_1","unstructured":"RobinsonA.OPTN Kidney Transplantation Committee report \"Eliminate Use of DSA and Region from Kidney Allocation 6 Month Post\u2010Implementation Monitoring Report\". Accessed March 8 2022.https:\/\/optn.transplant.hrsa.gov\/media\/z0ohhcut\/data_report_kidney_full_20211008_1_508_compliant.pdf"},{"key":"e_1_2_8_13_1","first-page":"1","article-title":"Moving toward continuous organ distribution","author":"Stewart D","year":"2021","journal-title":"Curr Transplant Rep."},{"key":"e_1_2_8_14_1","unstructured":"OPTN.Kidney and pancreas allocation proposals modified to advance 250 nautical mile distribution circle fewer proximity points. Kidney and pancreas allocation proposals modified to advance 250 nautical mile distribution circle fewer proximity points \u2010 OPTN (hrsa.gov) Accessed March 16 2022."},{"key":"e_1_2_8_15_1","unstructured":"OPTN.Kidney and pancreas distribution modeling: at a glance. Accessed March 16 2022.https:\/\/optn.transplant.hrsa.gov\/news\/kidney\u2010and\u2010pancreas\u2010distribution\u2010modeling\u2010analysis\u2010at\u2010a\u2010glance"},{"key":"e_1_2_8_16_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16156"},{"key":"e_1_2_8_17_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.15115"},{"key":"e_1_2_8_18_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16502"},{"key":"e_1_2_8_19_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2020030335"},{"key":"e_1_2_8_20_1","doi-asserted-by":"publisher","DOI":"10.2215\/CJN.06220617"},{"key":"e_1_2_8_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2010.03020.x"},{"key":"e_1_2_8_22_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12830"},{"key":"e_1_2_8_23_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.294.21.2726"},{"key":"e_1_2_8_24_1","doi-asserted-by":"publisher","DOI":"10.1681\/ASN.2014080837"},{"key":"e_1_2_8_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-6143.2012.04070.x"},{"key":"e_1_2_8_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.16826"},{"key":"e_1_2_8_27_1","doi-asserted-by":"publisher","DOI":"10.1038\/nrneph.2012.82"},{"key":"e_1_2_8_28_1","doi-asserted-by":"publisher","DOI":"10.1038\/ki.2013.206"},{"key":"e_1_2_8_29_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.12189"},{"key":"e_1_2_8_30_1","doi-asserted-by":"publisher","DOI":"10.1007\/s40472-017-0133-1"},{"key":"e_1_2_8_31_1","doi-asserted-by":"publisher","DOI":"10.1097\/TP.0b013e31824e75a5"},{"key":"e_1_2_8_32_1","doi-asserted-by":"publisher","DOI":"10.1093\/ndt\/gfu309"},{"key":"e_1_2_8_33_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13499"},{"key":"e_1_2_8_34_1","doi-asserted-by":"publisher","DOI":"10.1111\/ajt.13409"},{"key":"e_1_2_8_35_1","doi-asserted-by":"publisher","DOI":"10.1097\/TXD.0000000000001099"}],"container-title":["Clinical Transplantation"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14946","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1111\/ctr.14946","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/ctr.14946","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,8,19]],"date-time":"2023-08-19T11:18:54Z","timestamp":1692443934000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/ctr.14946"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,3,13]]},"references-count":34,"journal-issue":{"issue":"5","published-print":{"date-parts":[[2023,5]]}},"alternative-id":["10.1111\/ctr.14946"],"URL":"https:\/\/doi.org\/10.1111\/ctr.14946","archive":["Portico"],"relation":{},"ISSN":["0902-0063","1399-0012"],"issn-type":[{"value":"0902-0063","type":"print"},{"value":"1399-0012","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,3,13]]},"assertion":[{"value":"2022-07-29","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-02-08","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-03-13","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"e14946"}}