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Implementation notice: CPRA calculation change

Implementation notice: CPRA calculation change

Audience:  (Please share this notice with anyone in your organization who would benefit from it.)

Transplant programs

    • Program Administrators, Data Coordinators, Program Managers and Program Directors, Physicians, Surgeons
    • Support Staff-Clinical, Physician Assistant, Physician-Additional/Other, Clinical Coordinator, Surgeon-Additional/Other

Histocompatibility Labs:

    • Admins/Managers, Clinical Consultants, Lab Directors, Lab Directors in Training, General Supervisors, Supervisors, Lab Techs, Lab Technical Supervisors


    • Primary Contact, Alternate Contact, Match Offer Support

Implementation date

Jan. 26, 2023


A new formula for Calculated Panel Reactive Antibody (CPRA) is now in effect. Approved by the OPTN Board of Directors in June 2022, the revised CPRA calculation aims to more accurately reflect sensitization by:

  • Incorporating HLA-DQA1, DPB1, and DPA1 loci
  • Providing a CPRA value for allele-level antibodies
  • Using updated genotype frequencies based on a larger and newer dataset obtained from the National Marrow Donor Program (NMDP) donor registry

Candidates who do not have any unacceptable antigens reported no longer reflect a 0% CPRA. The CPRA score for those patients now appears as blank, or NULL, in the system. It is still possible for candidates to have a 0% CPRA when reporting unacceptable antigens that result in a calculated value of 0%.

These changes are also being applied to the KPD application in UNetSM.

Additionally, the updated candidate CPRA greater than 98% written approval form is available in WaitlistSM. The laboratory director and the candidate’s transplant physician or surgeon must review and sign a written approval of the unacceptable antigens listed for all candidates whose CPRA will be greater than 98%. These signatures must be entered in Waitlist for the candidate to receive additional allocation priority.

What you need to do

Transplant Hospital Programs can view which candidates still require documentation of written approval for CPRA greater than 98% by selecting Reports in Waitlist and then selecting ‘Kidney Candidate CPRA Greater than 98% Approvals Report’. If a candidate has at any point had >98% approvals entered in Waitlist previously, those entries will fulfill the requirement with this implementation as well.

Additional details

The OPTN site calculator has been updated to reflect the new CPRA changes.

Education and resources

Existing UNOS Connect courses on CPRA have been updated to reflect the new calculation.

A FAQ for patients is available on

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