Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story
Purpose: Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for trans...
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| Format: | Article |
| Language: | English |
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SAGE Publishing
2024-12-01
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| Series: | Canadian Journal of Kidney Health and Disease |
| Online Access: | https://doi.org/10.1177/20543581241306811 |
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| author | M. Khaled Shamseddin Steven Paraskevas Rahul Mainra Kyle Maru Bailey Piggott Darlene Jagusic Kathy Yetzer Lakshman Gunaratnam Christine Ribic Joseph Kim Sunita Singh Stephanie Hoar G. V. Ramesh Prasad Melanie Masse Isabelle Houde Myriam Khalili Kenneth West Rob Liwski Sean Martin Nessa Gogan Martin Karpinski Mauricio Monroy-Cuadros Sita Gourishankar Olwyn Johnston James Lan Christopher Nguen John Gill Michel Pâquet |
| author_facet | M. Khaled Shamseddin Steven Paraskevas Rahul Mainra Kyle Maru Bailey Piggott Darlene Jagusic Kathy Yetzer Lakshman Gunaratnam Christine Ribic Joseph Kim Sunita Singh Stephanie Hoar G. V. Ramesh Prasad Melanie Masse Isabelle Houde Myriam Khalili Kenneth West Rob Liwski Sean Martin Nessa Gogan Martin Karpinski Mauricio Monroy-Cuadros Sita Gourishankar Olwyn Johnston James Lan Christopher Nguen John Gill Michel Pâquet |
| author_sort | M. Khaled Shamseddin |
| collection | DOAJ |
| description | Purpose: Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for transplant and enhanced post-transplant outcomes. The Canadian HSP Program was established by Canadian Blood Services in collaboration with provincial organ donation and transplantation programs throughout the country to increase transplant opportunities for transplant candidates needing very specific matches from deceased kidney donors. Highly sensitized patients in the Canadian Program are defined by a calculated panel-reactive antibody (cPRA) ≥95%. In this report, we describe the evolution and trajectory of the Canadian HSP Program and evaluate the national impact on the first 1000 kidney transplant cases. Source of Information: To allocate deceased donor kidney organs nationally to HSPs and report on the Canadian HSP Program’s performance, Canadian Blood Services developed a national database registry known as the Canadian Transplant Registry (CTR) and an online reporting tool known as the Canadian HSP Program Data Dashboard. Methods: The CTR, which collects HSPs’ data for the purpose of matching potential donors to HSPs and as part of required national quality, safety, and efficiency performance measurements, was retrospectively reviewed. Due to the nature of using deidentified aggregate registry data, a patient consent form was not required. A Research Ethical Board (REB) application was also waived. Key Findings: In this article, we describe the historical development, initial deployment, and evolution of the Canadian HSP Program with a primary aim to increase the rate of deceased donor kidney transplantation. A secondary aim was to evaluate the national impact of the Canadian HSP Program on the first 1000 kidney transplant cases. Transplant candidates who have participated in the Canadian HSP Program and recipients who received transplants were predominantly females (average age 50 years, female 62%) with blood group O (47% of candidates, 42% of transplants). Seventy percent of all active transplant candidates enrolled in the HSP Program were in the hardest to match group (cPRA ≥99%), and only 22% of the transplant candidates with cPRA of 100% have received a transplant to date through the Program. The average times from first participation in the Canadian HSP Program to transplantation for cPRA ≥99% transplant recipients were significantly longer than for cPRA 95% to 98% recipients averaging 22 months versus 6 months, respectively. By the end of June 2024, the Canadian HSP Program had facilitated 1000 transplants, 613 of which were from interprovincial matches. The average (SD) cold ischemic time (CIT) was 14.5 (5.9) hours, with interprovincial transplants exhibiting significantly longer CITs compared with intraprovincial transplants, averaging an additional 4.7 hours. Limitations: Our study limitations include first that it is a retrospective registry data analysis with no available short- and long-term clinical outcomes data at this point (patient and graft survival). Second, given the nature of registry data, not all relevant data may have been captured and reporting may not be complete for all patients. Implications: Examination of CTR registry data showed the Canadian HSP Program had a meaningful impact in enabling 1000 HSPs to access transplantation opportunities that may otherwise be unavailable to them. |
| format | Article |
| id | doaj-art-a34e9226fbdb4fa6be914ba3d7faf75a |
| institution | DOAJ |
| issn | 2054-3581 |
| language | English |
| publishDate | 2024-12-01 |
| publisher | SAGE Publishing |
| record_format | Article |
| series | Canadian Journal of Kidney Health and Disease |
| spelling | doaj-art-a34e9226fbdb4fa6be914ba3d7faf75a2025-08-20T02:39:26ZengSAGE PublishingCanadian Journal of Kidney Health and Disease2054-35812024-12-011110.1177/20543581241306811Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants StoryM. Khaled Shamseddin0Steven Paraskevas1Rahul Mainra2Kyle Maru3Bailey Piggott4Darlene Jagusic5Kathy Yetzer6Lakshman Gunaratnam7Christine Ribic8Joseph Kim9Sunita Singh10Stephanie Hoar11G. V. Ramesh Prasad12Melanie Masse13Isabelle Houde14Myriam Khalili15Kenneth West16Rob Liwski17Sean Martin18Nessa Gogan19Martin Karpinski20Mauricio Monroy-Cuadros21Sita Gourishankar22Olwyn Johnston23James Lan24Christopher Nguen25John Gill26Michel Pâquet27Division of Nephrology, Department of Medicine, Queen’s University, ON, CanadaDepartment of Surgery, McGill University, Montreal, QC, CanadaDivision of Nephrology, Department of Medicine, University of Saskatchewan, Saskatoon, CanadaOrgan and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, CanadaOrgan and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, CanadaOrgan and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, CanadaOrgan and Tissue Donation and Transplantation, Canadian Blood Services, Ottawa, ON, CanadaDivision of Nephrology, Department of Medicine, Western University, London, ON, CanadaDivision of Nephrology, Department of Medicine, McMaster University, Hamilton, ON, CanadaDivision of Nephrology, Department of Medicine, University Health Network, University of Toronto, ON, CanadaDivision of Nephrology, Department of Medicine, University Health Network, University of Toronto, ON, CanadaDivision of Nephrology, Department of Medicine, University of Ottawa, ON, CanadaDivision of Nephrology, Department of Medicine, St. Michael’s Hospital, University of Toronto, ON, CanadaDivision of Nephrology, Department of Medicine, University of Sherbrooke, QC, CanadaDivision of Nephrology, Department of Medicine, Laval University, Quebec City, QC, CanadaDivision of Nephrology, Department of Medicine, Montreal University, QC, CanadaDivision of Nephrology, Department of Medicine, Dalhousie University, Halifax, NS, CanadaDepartment of Pathology and Laboratory Medicine, Dalhousie University, Halifax, NS, CanadaDivision of Nephrology, Department of Medicine, Memorial University, St. John’s, NL, CanadaSaint John Regional Hospital, Horizon Health Network, NB, CanadaSection of Nephrology, Department of Medicine, University of Manitoba, Winnipeg, CanadaDivision of Transplant Surgery, Department of Surgery, University of Calgary, AB, CanadaDivision of Nephrology and Transplant Immunology, Department of Medicine, University of Alberta, Edmonton, CanadaDivision of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, CanadaDivision of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, CanadaDepartment of Urological Sciences, The University of British Columbia, Vancouver, CanadaDivision of Nephrology, Department of Medicine, The University of British Columbia, Vancouver, CanadaDivision of Nephrology, Department of Medicine, Centre Hospitalier de l‘Université de Montréal, QC, CanadaPurpose: Highly sensitized patients (HSPs) with kidney failure have limited access to kidney transplantation and poorer post-transplant outcomes. Prioritizing HSPs in kidney allocation systems and expanding the pool of deceased donors available to them has helped to reduce their wait times for transplant and enhanced post-transplant outcomes. The Canadian HSP Program was established by Canadian Blood Services in collaboration with provincial organ donation and transplantation programs throughout the country to increase transplant opportunities for transplant candidates needing very specific matches from deceased kidney donors. Highly sensitized patients in the Canadian Program are defined by a calculated panel-reactive antibody (cPRA) ≥95%. In this report, we describe the evolution and trajectory of the Canadian HSP Program and evaluate the national impact on the first 1000 kidney transplant cases. Source of Information: To allocate deceased donor kidney organs nationally to HSPs and report on the Canadian HSP Program’s performance, Canadian Blood Services developed a national database registry known as the Canadian Transplant Registry (CTR) and an online reporting tool known as the Canadian HSP Program Data Dashboard. Methods: The CTR, which collects HSPs’ data for the purpose of matching potential donors to HSPs and as part of required national quality, safety, and efficiency performance measurements, was retrospectively reviewed. Due to the nature of using deidentified aggregate registry data, a patient consent form was not required. A Research Ethical Board (REB) application was also waived. Key Findings: In this article, we describe the historical development, initial deployment, and evolution of the Canadian HSP Program with a primary aim to increase the rate of deceased donor kidney transplantation. A secondary aim was to evaluate the national impact of the Canadian HSP Program on the first 1000 kidney transplant cases. Transplant candidates who have participated in the Canadian HSP Program and recipients who received transplants were predominantly females (average age 50 years, female 62%) with blood group O (47% of candidates, 42% of transplants). Seventy percent of all active transplant candidates enrolled in the HSP Program were in the hardest to match group (cPRA ≥99%), and only 22% of the transplant candidates with cPRA of 100% have received a transplant to date through the Program. The average times from first participation in the Canadian HSP Program to transplantation for cPRA ≥99% transplant recipients were significantly longer than for cPRA 95% to 98% recipients averaging 22 months versus 6 months, respectively. By the end of June 2024, the Canadian HSP Program had facilitated 1000 transplants, 613 of which were from interprovincial matches. The average (SD) cold ischemic time (CIT) was 14.5 (5.9) hours, with interprovincial transplants exhibiting significantly longer CITs compared with intraprovincial transplants, averaging an additional 4.7 hours. Limitations: Our study limitations include first that it is a retrospective registry data analysis with no available short- and long-term clinical outcomes data at this point (patient and graft survival). Second, given the nature of registry data, not all relevant data may have been captured and reporting may not be complete for all patients. Implications: Examination of CTR registry data showed the Canadian HSP Program had a meaningful impact in enabling 1000 HSPs to access transplantation opportunities that may otherwise be unavailable to them.https://doi.org/10.1177/20543581241306811 |
| spellingShingle | M. Khaled Shamseddin Steven Paraskevas Rahul Mainra Kyle Maru Bailey Piggott Darlene Jagusic Kathy Yetzer Lakshman Gunaratnam Christine Ribic Joseph Kim Sunita Singh Stephanie Hoar G. V. Ramesh Prasad Melanie Masse Isabelle Houde Myriam Khalili Kenneth West Rob Liwski Sean Martin Nessa Gogan Martin Karpinski Mauricio Monroy-Cuadros Sita Gourishankar Olwyn Johnston James Lan Christopher Nguen John Gill Michel Pâquet Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story Canadian Journal of Kidney Health and Disease |
| title | Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story |
| title_full | Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story |
| title_fullStr | Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story |
| title_full_unstemmed | Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story |
| title_short | Canadian Highly Sensitized Patient Program Report: A 1000 Kidney Transplants Story |
| title_sort | canadian highly sensitized patient program report a 1000 kidney transplants story |
| url | https://doi.org/10.1177/20543581241306811 |
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