Highly 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.

由于匹配困难和分配政策的不公平，高敏 (HS) 患者在全球范围内的已故供体肾移植 (DDKT) 候补名单上不断积累。巴西KT候补名单上HS患者的现状尚未公布。

回顾性评估了 2002 年至 2017 年在圣保罗州 KT 候补名单上登记的所有患者。患者根据其致敏程度分为 8 组，PRA 为 0%、>0–40%、>40–80%、>80–85%、>85–90%、>90–95%、>95 –98% 和 > 98%。通过竞争风险估计移植或死亡率/从候补名单中移除的累积发病率曲线。

在 50,249 名候补候选人中，1247 名被优先考虑，2467 名年龄 < 18 或 > 75 岁和 4152 名提交给活体捐赠者 KT 被排除在分析之外，其余 42,383 名患者。有 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% 和 911(2.2%) PRA > 98%。随着 PRA 的增加，优先排序的需要、KT 或候补名单上的等待时间和透析时间逐渐增加（p  < 0.001）。随着 PRA 的降低，DDKT 的概率明显增加，因此与 PRA > 98% 的患者相比，PRA 0% 的候选人更有可能被移植（HR：13.02，p  < 0.001）。PRA 的候补名单死亡率/移除率较高 > = 0.03), PRA > 90–95%(HR:1.10, p  = 0.05), PRA > 95–98%(HR:1.26,p < 0.001) 和 PRA > 98%(HR:1.09,p = 0.05) 患者与 PRA 零候选人相比。

由于缺乏静脉通路、更长的透析和候补时间、更低的 DDKT 概率和更高的候补死亡率/移除率，巴西圣保罗的 HS 患者需要更大的优先级。我们证实了巴西圣保罗 HS 患者获得 KT 的差异，表明需要新的策略来优化这一亚类患者的移植。