#3261 Impact on accessibility to renal transplantation in hipersensitized recipients with antigen avoidance based allocation in argentina

Abstract Background and Aims Patients with hypersensitivity (HP) are less likely to undergo transplantation. In August 2023, the Argentine Authority of Organ Procurement and Transplantation (INCUCAI) modified the regulations for distribution on the waiting list for renal transplantation, resulting in a change to the prioritisation of hypersensitised patients (HP). Patients presenting anti-HLA antibodies by solid-phase assay in excess of 85% are assigned renal donors as a priority in the distribution of deceased donors. Previously, the prioritisation criteria included the awarding of a supplementary score to the general waiting list score, which was comprised of time on dialysis and HLA match. However, this did not take into account the presence of antigens to be avoided in the donor. The aim of the present study is to evaluate the accessibility to transplantation of this group of patients as well as the results of patient and graft survival and the incidence of acute rejection. Method A cohort comparison study was conducted to examine the impact of the new regulations, implemented between the pre-period (10 November 2022 to 14 August 2023) and the post-period (15 August 2023 to 16 June 2024). The patients who received a deceased donor renal transplant were the subject of analysis. The pre-period cohort comprised 111 patients, while the post-period cohort comprised 236 patients. The prevalence and percentage of transplants (calculated on the total incidents on the waiting list of that period) of HP are described. The following transplant outcome variables were compared between both periods: graft loss and post-transplant death. Results A total of 5,420 patients are currently awaiting renal transplantation, of whom 546 have been identified as being hypersensitive. There were no statistically significant differences in dialysis time or cold ischemia time between the two groups. Similarly, there was no difference in post-transplant mortality between the two groups. However, there was an increase in the transplantation of hypersensitised patients following the modification of the regulations, The new policy resulted in a significant improvement in access to transplantation for hypersensitized patients on the waiting list, with 23% of these individuals gaining access, compared to the 6% access rate under previous criteria. Furthermore, the implementation of the new policy led to a notable reduction in the rate of rejection (P < 0.0001) and graft loss (P < 0.0001)—as illustrated in Table 1. Conclusion The implementation of an antigen-avoidance-based renal allocation policy for hypersensitised patients was associated with a significant increase in access to transplantation, a reduction in the incidence of acute rejection and graft loss.