Increasing Kidney-Exchange Options Within the Existing Living Donor Pool With CIAT: A Pilot Implementation Study

• Published in: Transplant international Vol. 36; p. 11112
• Main Authors: de Klerk, Marry, Kal-van Gestel, Judith A, Roelen, Dave, Betjes, Michiel G H, de Weerd, Annelies E, Reinders, Marlies E J, van de Wetering, Jacqueline, Kho, Marcia M L, Glorie, Kristiaan, Roodnat, Joke I
• Format: Journal Article
• Language: English
• Published: Switzerland Frontiers Media S.A 05.06.2023
• Subjects: Health Archive; Humans; Kidney; Kidney Transplantation; Living Donors; Tissue and Organ Procurement; HLA-desenzitisation transplantation; highly immunised; computerised allocation; kidney-exchange; AB0-desenzitisation
• ISSN: 1432-2277; 0934-0874; 1432-2277
• DOI: 10.3389/ti.2023.11112

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.