Disparity in the access to kidney transplantation for sensitized patients in the state of Sao Paulo-Brazil

Página do item simplificado
dc.contributor.authorPerosa, Marcelo
dc.contributor.authorFerreira, Gustavo F.
dc.contributor.authorModelli, Luis G.
dc.contributor.authorMedeiros, Marizete P.
dc.contributor.authorNeto, Soraia R.
dc.contributor.authorMoreira, Frederico
dc.contributor.authorZampieri, Fernando G.
dc.contributor.authorMarco, Renato de
dc.contributor.authorADRIANA BRUSCATO BORTOLUZZO
dc.contributor.authorVenezuela, Maria K.
dc.coverage.paisNão Informadopt_BR
dc.creatorPerosa, Marcelo
dc.creatorFerreira, Gustavo F.
dc.creatorModelli, Luis G.
dc.creatorMedeiros, Marizete P.
dc.creatorNeto, Soraia R.
dc.creatorMoreira, Frederico
dc.creatorZampieri, Fernando G.
dc.creatorMarco, Renato de
dc.creatorVenezuela, Maria K.
dc.date.accessioned2022-08-03T15:15:34Z
dc.date.available2022-08-03T15:15:34Z
dc.date.issued2021
dc.description.otherHighly sensitized (HS) patients accumulate on deceased donor kidney transplantation (DDKT) waitlists worldwide due to matching difficulty and inequity of allocation policies. Current situation of HS patients on KT waitlist in Brazil has not been published. All patients enrolled on the KT waitlist of the State of São Paulo from 2002 to 2017 were retrospectively assessed. Patients were divided into eight groups according to their degree of sensitization, PRA of 0%, >0–40%, >40–80%, >80–85%, >85–90%, >90–95%, >95–98% and > 98%. Cumulative incidence curves for transplantation or mortality/removal from waitlist were estimated by competing risk. Among 50,249 waitlisted candidates, 1247 prioritized, 2467 with age < 18 or > 75 years and 4152 submitted to living-donor KT were excluded from the analysis, remaining 42,383 patients. There were 29,664(70%) PRA 0%, 5611(13.2%) PRA > 0–40%, 3442(8.2%) PRA > 40–80%, 507(1.2%) PRA > 80–85%, 564(1.3%) PRA > 85–90%, 825(1.9%) PRA >90–95%, 859(2%) PRA > 95–98% and 911(2.2%) PRA > 98%. There was a progressive increase in the need of prioritization, waiting time for KT or on waitlist and time on dialysis as PRA increased (p < 0.001). Probability of DDKT clearly increased as PRA decreased so that PRA 0% candidates were much more likely to be transplanted compared to PRA > 98% patients(HR:13.02, p < 0.001). Waiting list mortality/removal was higher among PRA > 0–40%(HR1.05,p = 0.03), PRA > 90–95%(HR:1.10,p = 0.05), PRA > 95–98%(HR:1.26,p < 0.001) and PRA > 98%(HR:1.09,p = 0.05) patients compared to PRA zero candidates. HS patients in Sao Paulo-Brazil required greater prioritization due to lack of venous access, longer dialysis and waitlist times, lower probability of DDKT and higher rates of waitlist mortality/removal. We confirmed the disparity of access to KT among HS patients in Sao Paulo-Brazil, indicating the need of new strategies that optimize transplantation for this subcategory of patients.pt_BR
dc.format.extent101441pt_BR
dc.format.mediumDigitalpt_BR
dc.identifier.doihttps://doi.org/10.1016/j.trim.2021.10144pt_BR
dc.identifier.issn0966-3274pt_BR
dc.identifier.urihttps://repositorio.insper.edu.br/handle/11224/3850
dc.identifier.volume68pt_BR
dc.language.isoInglêspt_BR
dc.publisherElsevierpt_BR
dc.relation.ispartofTransplant Immunologypt_BR
dc.rights.licenseO INSPER E ESTE REPOSITÓRIO NÃO DETÊM OS DIREITOS DE USO E REPRODUÇÃO DOS CONTEÚDOS AQUI REGISTRADOS. É RESPONSABILIDADE DOS USUÁRIOS INDIVIDUAIS VERIFICAR OS USOS PERMITIDOS NA FONTE ORIGINAL, RESPEITANDO-SE OS DIREITOS DE AUTOR OU EDITOR;pt_BR
dc.subject.keywordsKidney transplantationpt_BR
dc.subject.keywordsWaiting listpt_BR
dc.subject.keywordsTransplantationpt_BR
dc.subject.keywordsSensitizationpt_BR
dc.subject.keywordsHighly sensitizedpt_BR
dc.titleDisparity in the access to kidney transplantation for sensitized patients in the state of Sao Paulo-Brazilpt_BR
dc.typejournal article
dspace.entity.typePublication
local.identifier.sourceUrihttps://www.sciencedirect.com/science/article/pii/S0966327421000812
local.subject.cnpqCiências da Saúdept_BR
local.typeArtigo Científicopt_BR
relation.isAuthorOfPublicationccfd47d5-bd80-4464-98ce-629abb672e3d
relation.isAuthorOfPublication.latestForDiscoveryccfd47d5-bd80-4464-98ce-629abb672e3d

Arquivos

Coleções

Coleção de Artigos Acadêmicos