Sensitization and Deceased-Donor Kidney Transplant Access in France
Year: 2026
Type: article
Study design: Observational Study
Abstract: Introduction: (TGI)' however, the sensitization threshold at which this system fails to preserve equity remains unclear. Methods: We conducted a retrospective multicenter cohort study including 14,485 adult kidney transplant candidates listed between 2011 and 2021. Sensitization was measured using TGI (0-100) and reported using calculated panel reactive antibody (cPRA)-labeled strata for international readability. Access to DDKT was the primary outcome, with living-donor transplantation, death, and delisting treated as competing events. The secondary outcome was waitlist attrition (death or delisting). Fine-Gray models adjusted for key demographic, clinical, and immunologic variables were truncated at 10 years. Results: Access to DDKT declined progressively with increasing sensitization and fell sharply from cPRA ≥ 96%. Compared with cPRA 0%, the adjusted subdistribution hazard ratio (SHR) for DDKT was 0.781 at 96%, 0.658 at 97%, 0.701 at 98%, 0.353 at 99%, and 0.082 at 100%. Conversely, the risk of waitlist attrition increased from cPRA ≥ 97% (sHR: 1.793), reaching 2.713 at 100%. Candidates with cPRA of 85% to 95% retained preserved access, consistent with the intended effect of the acceptable-antigen pathway. Conclusion: In the French TGI-based allocation system, cPRA ≥ 96% marks a threshold of impaired access to DDKT, whereas cPRA ≥ 97% identifies excess waitlist attrition. These findings define an ultrasensitized subgroup insufficiently served by current prioritization and support refined allocation strategies within the 96% to 100% range.
Source: Kidney International Reports
Institutions: Centre Hospitalier Universitaire de Rouen, Université de Tours, Centre Hospitalier Universitaire de Tours, Centre Hospitalier Universitaire Amiens-Picardie, Centre Hospitalier Universitaire de Reims, Centre Hospitalier Universitaire de Limoges, Centre Hospitalier Universitaire d'Angers, Centre Hospitalier Universitaire de Poitiers, Centre Hospitalier Universitaire de Clermont-Ferrand, Centre Hospitalier Régional Universitaire de Brest, Centre Hospitalier Universitaire de Rennes, Centre Hospitalier Universitaire de Caen Normandie, Hôpitaux Universitaires de Strasbourg, Hôpital Necker-Enfants Malades, Assistance Publique – Hôpitaux de Paris
Language: English
Subfield: Transplantation
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,800
OpenAlex ID: W7126446993