In collaboration with Dr. James Lan at University of British Columbia, we have developed a new metric for immune sensitization that can be applied to improve equity in organ allocation systems, ABO-adjusted calculated panel reactive antibody (cPRA).
Candidates waiting to receive kidneys who have antibodies against HLA are given increased points and priority in organ allocation. Because their pool of compatible donors is smaller, these patients would otherwise not have an equal chance at getting transplanted. The fewer compatible donors, the more points and priority are needed to ensure equity.
Our innovation is applying James’s idea to treat national antibodies against donor ABO blood group in the same way as antibodies against donor HLA.
Patients who are in blood group B and O have decreased access to transplant, and the frequency of B blood group is double in African Americans versus Whites.
Prioritizing transplant candidates with ABO-adjustment combined with policy changes for organ allocation that would allow for more ABO-compatible transplants will expand access and improve equity.
We have developed a web calculator to demonstrate the concept, providing cPRA with and without ABO-adjustment. https://transplanttoolbox.org/abo_hla_cpra/
Please see find our new publication in American Journal of Transplantation.