Survival of Highly Sensitized Patients on the Waiting List for Kidney Transplantation at Modena Transplant Center

Background: HLA sensitization plays a pivotal role in kidney transplantation. The presence of anti HLA antibodies strongly limits access to transplantation to subjects on the waiting list, particularly for highly sensitized patients. The aim of this study is to evaluate the waiting time of highly sensitized candidates, when compared with patients with a lower level of sensitization, and the respective survival rates on the waiting list. Methods: We conducted a single center retrospective observational study stratified according to calculated panel reactive antibodies (cPRAs) in highly sensitized patients (cPRA ≥ 80%) and patients with a lower level of sensitization (NH; cPRA < 80%). A total of 911 patients on the waiting list were considered. Survival analysis was performed according to Kaplan Meier, and multivariate analysis was performed with Cox regression. Mortality data were collected only for 222 patients who were residents in the Province of Modena, Italy. Results: Highly sensitized subjects have a significantly longer waiting time from enrollment to kidney transplantation when compared to patients with a lower level of sensitization, but in our highly sensitized patients the mortality rate resulted slightly lower because of the protective effect of a younger age at enrollment. Conclusions: Highly sensitized patients wait longer to achieve kidney transplantation, but they do not show worse survival rates, likely because of a younger age at enrollment. These results highlight the importance of innovative strategies to allow access to transplantation to highly sensitive subjects to limit the personal and social cost of a prolonged stay on dialysis.