CIAT: A New Kidney Exchange Program with Better Options for Highly Sensitized and Long Waiting Patients

M. d. Klerk¹, J. Kal¹, D. L. Roelen², M. Betjes¹, A. Weerd de¹, M. Reinders¹, M. Kho¹, K. Glorie³, J. I. Roodnat¹

¹Internal Medicine, Erasmus MC Transplant Institute, Rotterdam, Netherlands, ²Immunology, Leids UMC, Netherlands, ³Econometrics, EUR, Rotterdam, Netherlands

Meeting: 2022 American Transplant Congress

Abstract number: 496

Keywords: Allocation, Donors, unrelated, Highly-sensitized, Kidney transplantation

Topic: Clinical Science » Kidney » 48 - Kidney Paired Exchange

Session Information

Session Name: Kidney Living Donor & Paired Exchange

Session Type: Rapid Fire Oral Abstract

Date: Tuesday, June 7, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 6:30pm-6:40pm

Location: Hynes Room 302

*Purpose: A number of alternative, both living and deceased donor kidney transplant programs have been developed for incompatible pairs and difficult to match patients. The Dutch kidney exchange program (KEP) is the only computer based and nationally operating program. All other programs function locally and are interrelated but unstructured. Despite all these programs, there are still many long waiting (LW) and highly immunized patients (HI) waitlisted. Computerised Integration of Alternative Transplantation (CIAT) programs was developed to increase the chances of HI and LW candidates. CIAT integrates AB0- and HLA-desensitization, donor-exchange, altruistic and domino-paired donation. Strict criteria were defined for selected HI (sHI) patients. sHI patients are given priority and AB0-incompatible (AB0i) and/or HLA-incompatible matching (HLAi) is allowed. LW candidates can opt for an AB0i match.

*Methods: A pilot was established in our center between 2017-2021 to gain logistic experience, to test the algorithm and to optimize the program. Participation in CIAT as LW or sHI was discussed and decided by a standing committee. CIAT results were assessed in comparison with other available deceased and living donor transplant programs.

*Results: 105 incompatible pairs participated. 35% were transplanted via CIAT, 24% received a direct kidney transplantation (other, compatible donor or after AB0 and/or HLA desensitisation), 20% were delisted or still waiting, 11% received a deceased donor kidney, 10% via national KEP. There were 47 sHI patients, 60% was not transplanted. The majority of those transplanted, received the kidney via the CIAT (17%), while 15% received an AM-deceased kidney, 6% were direct transplantations via HLAi and 2% via national KEP. There were 55 LW patients of whom 50% received a deceased kidney, 24% via the CIAT, 24% is delisted or still waiting, 1% received a compatible direct living donor.

*Conclusions: CIAT is a major addition to the limited number of existing programs that enable kidney transplantation in difficult to match patients. CIAT is a strong improvement over the current National KEP. For LW patients the major contribution is by the Eurotransplant deceased program, CIAT is second for LW patients. CIAT contributed most to successful transplantations in HI patients and incompatible couples compared to all other programs available for these specific groups.

To cite this abstract in AMA style:

Klerk Md, Kal J, Roelen DL, Betjes M, de AWeerd, Reinders M, Kho M, Glorie K, Roodnat JI. CIAT: A New Kidney Exchange Program with Better Options for Highly Sensitized and Long Waiting Patients [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/ciat-a-new-kidney-exchange-program-with-better-options-for-highly-sensitized-and-long-waiting-patients/. Accessed May 6, 2025.

« Back to 2022 American Transplant Congress