Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System

Area of Science:

• Nephrology
• Transplantation Surgery
• Immunology

Background:

• Kidney paired donation (KPD) is crucial for increasing kidney transplant rates.
• Many computer-identified KPD exchanges do not result in transplants, limiting KPD's potential.
• Analyzing the conversion of KPD offers to transplants is essential for improving outcomes.

Purpose of the Study:

• To analyze the progression of KPD exchanges from initial offers to completed transplants.
• To identify reasons for failure in the KPD process.
• To evaluate the impact of protocol and software improvements on KPD success rates.

Main Methods:

• Offers were segmented into 1-way transplants to calculate success rates.
• Analysis of 243 transplants performed by the Alliance for Paired Donation (APD) from 2007-2014.
• Categorization of transplant failures into preventable causes: positive crossmatch, transplant center declination, and external transplants.

Main Results:

• The overall offer and 1-way transplant success rates were 21.9% and 15.5%, respectively.
• Nonsimultaneous extended altruistic donor (NEAD) chains accounted for 68.6% of independent transplants.
• Top failure reasons included positive crossmatch (28%), transplant center declination (17%), and external transplantation (14%).

Conclusions:

• Root cause analysis of KPD failures enables targeted improvements in protocols and software.
• Implementation of these changes has successfully enhanced KPD success rates and increased annual transplant volume.
• Optimizing the KPD process is vital for maximizing its contribution to kidney transplantation.