Computerised Integration of Alternative kidney Transplantation (CIAT) programs to improve transplants for HI patients: a simulation

M. de Klerk, J.A. Kal-van Gestel, S. Middel-de Sterke, J. van de Wetering, M.M.L. Kho, M.G.H. Betjes, W.C. Zuidema, D.L. Roelen, K.M. Glorie, J.I. Roodnat

Wednesday 13 march 2019

14:02 - 14:04h at Mauritszaal

Categories: Klinisch, Parallelsessie

Parallel session: Parallelsessie IV - Klinisch I

Background: A selected group of highly immunised patients (sHI), participates unsuccessfully in transplant programs while donor specific antibody levels (DSA) are too high for desensitisation. In 2016, in an extremely laborious procedure, one couple with an sHI recipient had been matched using domino-paired, kidney-exchange, ABOi and desensitisation programs at the time for this one transplantation. The unacceptables of the new donor were fewer and had lower MFI’s compared to the original donor. Our experience with this patient eventually led to the initiation of CIAT (Computer program for Integration of Alternative Transplantation programs). CIAT was developed to integrate kidney-exchange, altruistic donation, ABO incompatible and desensitization programs. sHI patients were prioritized and ABOi and HLAi combinations were allowed for them.

Methods: In collaboration with Erasmus Q-Intelligence a computer program was developed to integrate all alternative programs. We aimed at prioritizing sHI patients without diminishing the chances of the other patients. To compare CIAT with reality, a simulation was carried out including waitlisted patients, unspecified donors and HLAi and/or ABOi pairs that participated in our programs in 2015-2016. sHI patients were introduced with all their unacceptables and, in order to increase their chances also with reduced number of unacceptables. For reduction of unacceptables MFI

Results: In the period studied 40 unspecified donors, 63 exchange pairs and 20 sHI patients were registered. In reality, 90 alternative program transplantations were carried out: 73 compatible, 16 ABOi transplants and 1 ABOi and HLAi combination in a sHI patient (the index patient). In the simulationthe CIAT program found 95 matches: 83 compatible (including 1 sHI) and 5 ABOi matches. Eight sHI patients were matched: 1 compatible, 6 HLAi with anti donor MFI<8000(1 was also ABOi), and 1 ABOi match.

Conclusions: Our simulation showed that computer driven integration leads to 14% more compatible matches. Additionally, 8 times as much matches were found for sHI-patients. These offered them better chances in the desensitisation program because of a more favourable MFI profile against the new donor. Integration of all alternative donation programs and prioritisation of sHI patients not only leads to better transplant opportunities for sHI patients, but also to an increase of the number of compatible matches.