TY - JOUR
T1 - Increasing Kidney-Exchange Options Within the Existing Living Donor Pool With CIAT
T2 - A Pilot Implementation Study
AU - de Klerk, Marry
AU - Kal-van Gestel, Judith A.
AU - Roelen, Dave
AU - Betjes, Michiel G.H.
AU - de Weerd, Annelies E.
AU - Reinders, Marlies E.J.
AU - van de Wetering, Jacqueline
AU - Kho, Marcia M.L.
AU - Glorie, Kristiaan
AU - Roodnat, Joke I.
N1 - Funding Information:
Funding by Foundation “Een nier voor Jeroen”.
Publisher Copyright:
Copyright © 2023 de Klerk, Kal-van Gestel, Roelen, Betjes, de Weerd, Reinders, van de Wetering, Kho, Glorie and Roodnat.
PY - 2023
Y1 - 2023
N2 - Computerized integration of alternative transplantation programs (CIAT) is a kidney-exchange program that allows AB0- and/or HLA-incompatible allocation to difficult-to-match patients, thereby increasing their chances. Altruistic donors make this available for waiting list patients as well. Strict criteria were defined for selected highly-immunized (sHI) and long waiting (LW) candidates. For LW patients AB0i allocation was allowed. sHI patients were given priority and AB0i and/or CDC cross-match negative HLAi allocations were allowed. A local pilot was established between 2017 and 2022. CIAT results were assessed against all other transplant programs available. In the period studied there were 131 incompatible couples; CIAT transplanted the highest number of couples (35%), compared to the other programs. There were 55 sHI patients; CIAT transplanted as many sHI patients as the Acceptable Mismatch program (18%); Other programs contributed less. There were 69 LW patients; 53% received deceased donor transplantations, 20% were transplanted via CIAT. In total, 72 CIAT transplants were performed: 66 compatible, 5 AB0i and 1 both AB0i and HLAi. CIAT increased opportunities for difficult-to-match patients, not by increasing pool size, but through prioritization and allowing AB0i and “low risk” HLAi allocation. CIAT is a powerful addition to the limited number of programs available for difficult-to-match patients.
AB - Computerized integration of alternative transplantation programs (CIAT) is a kidney-exchange program that allows AB0- and/or HLA-incompatible allocation to difficult-to-match patients, thereby increasing their chances. Altruistic donors make this available for waiting list patients as well. Strict criteria were defined for selected highly-immunized (sHI) and long waiting (LW) candidates. For LW patients AB0i allocation was allowed. sHI patients were given priority and AB0i and/or CDC cross-match negative HLAi allocations were allowed. A local pilot was established between 2017 and 2022. CIAT results were assessed against all other transplant programs available. In the period studied there were 131 incompatible couples; CIAT transplanted the highest number of couples (35%), compared to the other programs. There were 55 sHI patients; CIAT transplanted as many sHI patients as the Acceptable Mismatch program (18%); Other programs contributed less. There were 69 LW patients; 53% received deceased donor transplantations, 20% were transplanted via CIAT. In total, 72 CIAT transplants were performed: 66 compatible, 5 AB0i and 1 both AB0i and HLAi. CIAT increased opportunities for difficult-to-match patients, not by increasing pool size, but through prioritization and allowing AB0i and “low risk” HLAi allocation. CIAT is a powerful addition to the limited number of programs available for difficult-to-match patients.
UR - http://www.scopus.com/inward/record.url?scp=85162262601&partnerID=8YFLogxK
U2 - 10.3389/ti.2023.11112
DO - 10.3389/ti.2023.11112
M3 - Article
C2 - 37342179
AN - SCOPUS:85162262601
SN - 0934-0874
VL - 36
JO - Transplant International
JF - Transplant International
M1 - 11112
ER -