Transplant immunology · 2025
Temporal dynamics of cPRA levels and their categorical impact on waitlist longevity in Ecuadorian kidney transplant candidates: A 2011-2022 Nationwide cohort analysis.
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Garrido David, Jeréz Verónica, Huertas Jorge
Аннотация
BACKGROUND: Chronic kidney disease is a major public health concern for which kidney transplantation offers the best survival benefit. Patients with high calculated panel-reactive antibody (cPRA) levels often face extended waiting times owing to donor compatibility challenges.
METHODS: We conducted a descriptive, cross-sectional analysis of all 724 kidney transplant candidates on Ecuador's national waiting list between 2011 and 2022, using anonymized INDOT data. cPRA values were obtained with solid-phase, bead-based luminometric assays. We applied descriptive statistics, Joinpoint regression to assess temporal trends, Spearman correlation for cPRA versus waiting time, chi-square tests for categorical comparisons, and logistic regression to estimate odds ratios (ORs) for prolonged waiting time (>5 years).
RESULTS: Overall, 166 candidates (22.9 %) had cPRA ≥20 %. Of these, 86 (51.8 %) exhibited cPRA ≥75 %. The number of sensitized patients with cPRA ≥75 % rose from one in 2011 to nineteen in 2022 (annual percent change 10.4 %). Median waiting time was 54.5 months for candidates with cPRA ≥75 % versus 51.5 months for those with cPRA 20-74 %; there was no linear correlation between cPRA and waiting time (ρ = 0.11, p = 0.18). However, candidates with cPRA ≥75 % were more likely to wait >5 years than those below this threshold (44.2 % vs. 25.0 %; OR 2.38; p = 0.01), and a similar pattern was observed for candidates with cPRA ≥70 % (OR 2.98; p = 0.003).
CONCLUSION: The proportion of highly sensitized candidates has increased substantially between 2011 and 2022. Patients with cPRA levels ≥75 % were associated with prolonged waitlist time to obtain a kidney transplant. Prospective studies are warranted to explore underlying mechanisms and inform allocation strategies.
METHODS: We conducted a descriptive, cross-sectional analysis of all 724 kidney transplant candidates on Ecuador's national waiting list between 2011 and 2022, using anonymized INDOT data. cPRA values were obtained with solid-phase, bead-based luminometric assays. We applied descriptive statistics, Joinpoint regression to assess temporal trends, Spearman correlation for cPRA versus waiting time, chi-square tests for categorical comparisons, and logistic regression to estimate odds ratios (ORs) for prolonged waiting time (>5 years).
RESULTS: Overall, 166 candidates (22.9 %) had cPRA ≥20 %. Of these, 86 (51.8 %) exhibited cPRA ≥75 %. The number of sensitized patients with cPRA ≥75 % rose from one in 2011 to nineteen in 2022 (annual percent change 10.4 %). Median waiting time was 54.5 months for candidates with cPRA ≥75 % versus 51.5 months for those with cPRA 20-74 %; there was no linear correlation between cPRA and waiting time (ρ = 0.11, p = 0.18). However, candidates with cPRA ≥75 % were more likely to wait >5 years than those below this threshold (44.2 % vs. 25.0 %; OR 2.38; p = 0.01), and a similar pattern was observed for candidates with cPRA ≥70 % (OR 2.98; p = 0.003).
CONCLUSION: The proportion of highly sensitized candidates has increased substantially between 2011 and 2022. Patients with cPRA levels ≥75 % were associated with prolonged waitlist time to obtain a kidney transplant. Prospective studies are warranted to explore underlying mechanisms and inform allocation strategies.