{
  "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.",
  "abstract_shown": true,
  "affiliations": [],
  "article_type": null,
  "arxiv": null,
  "author_total": 13,
  "authors": [
    {
      "name": "Dominique Bertrand"
    },
    {
      "name": "Philippe Gatault"
    },
    {
      "name": "Coralie Poulain"
    },
    {
      "name": "Charlotte Colosio"
    },
    {
      "name": "Clément Danthu"
    },
    {
      "name": "Agnès Duveau"
    },
    {
      "name": "Laure Ecotière"
    },
    {
      "name": "Cyril Garrouste"
    },
    {
      "name": "Yannick Le Meur"
    },
    {
      "name": "Marie-Pascale Morin"
    },
    {
      "name": "Valérie Châtelet"
    },
    {
      "name": "Sophie Caillard"
    },
    {
      "name": "Dany Anglicheau"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/9ed82r8vkbhp6.bib",
  "cited_by": 2,
  "doi": "10.1016/j.ekir.2026.106340",
  "fulltext_url": null,
  "id": "9ed82r8vkbhp6",
  "issns": [
    "2468-0249"
  ],
  "landing_url": "https://hal.science/hal-05837485v1",
  "language": "en",
  "licence": "CC-BY",
  "licence_label": "CC BY",
  "licence_source": "journal",
  "licence_url": "https://creativecommons.org/licenses/by/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "hal",
      "0.sdv"
    ],
    [
      "hal",
      "1.sdv.imm"
    ],
    [
      "openalex",
      "2747|Renal Transplantation Outcomes and Treatments"
    ]
  ],
  "openalex": "W7126446993",
  "pdf_url": null,
  "pmcid": null,
  "pmid": "41853743",
  "published": "2026-10-23",
  "publisher": "Elsevier",
  "ris": "https://research.draconitic.com/paper/9ed82r8vkbhp6.ris",
  "sources": [
    {
      "first_seen": "2026-10-30T12:18:01Z",
      "native_id": "hal-05837485",
      "source": "hal",
      "url": "https://hal.science/hal-05837485v1"
    }
  ],
  "subjects": [
    {
      "field": "biology",
      "origin": "hal:1.sdv.imm",
      "subfield": "immunology"
    }
  ],
  "title": "Sensitization and Deceased-Donor Kidney Transplant Access in France",
  "title_text": "Sensitization and Deceased-Donor Kidney Transplant Access in France",
  "type": "peer-reviewed",
  "updated_at": "2026-10-30T12:18:01Z",
  "url": "https://research.draconitic.com/paper/9ed82r8vkbhp6",
  "venue": "Kidney International Reports",
  "versions": []
}