Sensitization and Deceased-Donor Kidney Transplant Access in France
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.
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BibTeX
@article{bertrand2026sensitization,
title = {{Sensitization and Deceased-Donor Kidney Transplant Access in France}},
author = {Dominique Bertrand and Philippe Gatault and Coralie Poulain and Charlotte Colosio and Clément Danthu and Agnès Duveau and Laure Ecotière and Cyril Garrouste and Yannick Le Meur and Marie-Pascale Morin and Valérie Châtelet and Sophie Caillard and Dany Anglicheau},
journal = {Kidney International Reports},
year = {2026},
month = oct,
doi = {10.1016/j.ekir.2026.106340},
url = {https://hal.science/hal-05837485v1},
note = {CC BY},
}
RIS
TY - JOUR
TI - Sensitization and Deceased-Donor Kidney Transplant Access in France
AU - Dominique Bertrand
AU - Philippe Gatault
AU - Coralie Poulain
AU - Charlotte Colosio
AU - Clément Danthu
AU - Agnès Duveau
AU - Laure Ecotière
AU - Cyril Garrouste
AU - Yannick Le Meur
AU - Marie-Pascale Morin
AU - Valérie Châtelet
AU - Sophie Caillard
AU - Dany Anglicheau
PY - 2026
DA - 2026/10/23
JO - Kidney International Reports
DO - 10.1016/j.ekir.2026.106340
UR - https://hal.science/hal-05837485v1
AB - 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.
SN - 2468-0249
ER -