Computerised Integration of Alternative kidney Transplantation (CIAT) programs: a simulation

M. de Klerk, J.A. Kal, S. Middel, J. van de Wetering, M.M.L. Kho, M.G.H. Betjes, W.C. Zuidema, D.L. Roelen, K.M. Glorie, J.I. Roodnat

Friday 16 march 2018

10:05 - 10:10h at Willem Burger Foyer

Categories: Clinical, Session (poster)

Parallel session: Poster session 7: Clinical

Introduction

Though kidney-exchange is intertwined with alternative transplant procedures such as unspecified donation, domino-paired donation and desensitisation, these alternative procedures are still coordinated by hand and on a local level. Desensitisation results are better for transplants with current negative but historically positive CDC cross matches (CDC-XM) compared to current positive CDC-XM. An anti HLA Luminex®SA MFI

Methods

An algorithm was developed to maximize the number of HI patients transplanted. For selected highly immunised (SHI) patients (PRA>85%) AB0i and MFI

Results

In reality in 2015, there were 3 National kidney-exchange transplants. 23 unspecified donors donated: 9 donors initiated chains, 14 donated to the waitlist. In total 44 transplantations were carried out: 37 AB0 and HLA compatible and 7 AB0i transplantations. None of the HI patients were matched. In the CIAT simulations 10 unspecified donors were matched to the waitlist and 13 donors initiated chains. In total 48 matches were found: 44 AB0- and HLA-compatible matches, 3 HLAi matches for SHI patients (anti donor MFI<8000,1 also AB0i) and 1 AB0i match. For these 3 SHI patients, desensitisation is still indispensable.

Conclusion

Computer allocation to integrate transplant programs could lead to 20% more AB0 and HLA compatible matches. Besides, for 3 HLA incompatible pairs we found a match with a better chance for successful desensitisation. Success rate of an integrated program depends on the number of couples and unspecified donors included, and on the time of their inclusion. Expansion of the pool through national cooperation and inclusion of compatible kidney exchange pairs may increase the yield of the integrated program.