Creating Options for Difficult-to-match Kidney Transplant Candidates

Area of Science:

• Nephrology
• Transplantation Immunology
• Medical Informatics

Background:

• Difficult-to-match patients, often highly immunized or with specific ABO blood types, face prolonged waits for kidney transplantation.
• Existing transplantation programs struggle to accommodate patients with complex immunological profiles.

Purpose of the Study:

• To evaluate the effectiveness of Computerized Integration of Alternative Transplantation programs (CIAT) in improving transplant outcomes for difficult-to-match kidney patients.
• To compare the simulated performance of CIAT with actual transplantation data.

Main Methods:

• A simulation was conducted using data from 2015-2016, including patients, donors, and pairs.
• Difficult-to-match criteria included high virtual panel reactive antibody (>85%) and prolonged program participation.
• The CIAT simulation allowed for ABO and HLA incompatible (ABOi/HLAi) matching with specific donor-specific antigen-mean fluorescence intensity (MFI) thresholds.

Main Results:

• The CIAT simulation projected 95 hypothetical transplantations, compared to 90 actual alternative program transplantations.
• Eight difficult-to-match patients were successfully matched through CIAT, with six of these combinations being complement-dependent cytotoxicity cross-match negative.
• CIAT facilitated more ABO compatible matches for ABO incompatible couples and increased matches for selected-highly immunized (sHI) patients.

Conclusions:

• CIAT significantly enhanced transplant opportunities for difficult-to-match patients, particularly selected-highly immunized (sHI) individuals.
• The system offers better donor-specific antigen-mean fluorescence intensity (MFI) profiles for sHI patients.
• Prioritizing difficult-to-match patients via CIAT improves their outcomes without compromising the overall transplantation rate.