Abstract
Background. Most transplantation centers recognize a small patient population that unsuccessfully participates in all available, both living and deceased donor, transplantation programs for many years: the difficult-to-match patients. This population consists of highly immunized and/or ABO blood group O or B patients. Methods. To improve their chances, Computerized Integration of Alternative Transplantation programs (CIAT) were developed to integrate kidney paired donation, altruistic/unspecified donation, and ABO and HLA desensitization. To compare CIAT with reality, a simulation was performed, including all patients, donors, and pairs who participated in our programs in 2015-2016. Criteria for inclusion as difficult-to-match, selected-highly immunized (sHI) patient were as follows: virtual panel reactive antibody >85% and participating for 2 years in Eurotransplant Acceptable Mismatch program. sHI patients were given priority, and ABO blood group incompatible (ABOi) and/or HLA incompatible (HLAi) matching with donor-specific antigen-mean fluorescence intensity (MFI) <8000 were allowed. For long-waiting blood group O or B patients, ABOi matches were allowed. Results. In reality, 90 alternative program transplantations were carried out: 73 compatible, 16 ABOi, and 1 both ABOi and HLAi combination. Simulation with CIAT resulted in 95 hypothetical transplantations: 83 compatible (including 1 sHI) and 5 ABOi combinations. Eight sHI patients were matched: 1 compatible, 6 HLAi with donor-specific antigen-MFI <8000 (1 also ABOi), and 1 ABOi match. Six/eight combinations for sHI patients were complement-dependent cytotoxicity cross-match negative. Conclusions. CIAT led to 8 times more matches for difficult-to-match sHI patients. This offers them better chances because of a more favorable MFI profile against the new donor. Besides, more ABO compatible matches were found for ABOi couples, while total number of transplantations was not hampered. Prioritizing difficult-to-match patients improves their chances without affecting the chances of regular patients.
| Original language | English |
|---|---|
| Pages (from-to) | 240-248 |
| Number of pages | 9 |
| Journal | Transplantation |
| Volume | 105 |
| Issue number | 1 |
| DOIs | |
| Publication status | Published - Jan 2021 |
Bibliographical note
Funding Information:3Erasmus Q-Intelligence, Erasmus University Rotterdam, Rotterdam, The Netherlands. This study was supported by Foundation “Een nier voor Jeroen.” The authors declare no conflicts of interest. M.d.K. participated in research design, performance of the research, data analysis, and writing of the article. J.A.K.-v.G. participated in the performance of the research, data analysis, and writing of the article. J.v.d.W., M.L.K., S.M.-d.S., and M.G.H.B. participated in research design and writing of the article. W.C.Z. participated in writing of the article. D.R. participated in research design and writing of the article. K.G. participated in research design, built the program, and participated in writing of the article. J.I.R. participated in research design, performance of the research, data analysis, and writing of the article. Correspondence: Joke I. Roodnat, MD, PhD, Department of Internal Medicine, Room RG529, Erasmus MC Rotterdam, The Netherlands. (J.Roodnat@eras-musmc.nl). Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved. ISSN: 0041-1337/21/1051-240 DOI: 10.1097/TP.0000000000003203
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Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.