The calculated panel reactive antibody policy: an advancement improving organ allocation

Purpose of review A major policy change affecting renal organ allocation to sensitized patients in the US was implemented in October, 2009. Extra allocation points are awarded to sensitized patients based on a calculated panel reactive antibody (CPRA). This review will discuss the reasons underlying this policy change and examine the evidence to date of its impact on renal allocation. Recent findings Comparison of both the proportion and transplant rates of sensitized renal transplant candidates during the 6 months prior to the policy implementation and 6 months after implementation showed a significant increase in transplantation of sensitized patients, with the greatest difference occurring among broadly sensitized patients with CPRA values of 80 or greater. Whereas there was a decrease in transplant rates among candidates with CPRA values from 1 to 20, both this decrease and the increased rates among the more highly sensitized recipients were proportional to the distributions of these groups on the wait list. Notably, following the policy change, there was a highly significant decrease in organ refusals due to positive cross-matches with an 83% reduction between the 6-month periods prior to and after the policy implementation. Additional analyses have recently shown the continuation of these trends 1 year after the policy implementation. Summary Implementation of the CPRA policy on national renal organ allocation in the US has increased efficiency in organ allocation and is helping to facilitate transplantation of broadly sensitized candidates.