Even if blood type incompatibility (ABOi) is one of the most significant barriers in transplantation, recent studies report that the outcomes of ABOi transplants with desensitization are comparable to those of ABO transplants. ABOi desensitization is receiving increasingly more attention as a promising intervention performed in a KPD framework. Currently, donors and recipients in a KPD run are matched by means of optimization models, which maximize the total number of matches. These models exclusively look for the best possible match without considering the possibility of integrating KPD and ABOi desensitization, often resulting in less than 15% of highly sensitized patients (i.e., patients with percentage reactive antibody (PRA) greater than or equal to 80), finding a compatible pair in a match run. The objective of this study is to overcome this limit of the current models and evaluate the benefit of integrating ABOi desensitization protocols into a KPD program.

Methods: Given a set of incompatible pairs, we use an optimization model to maximize the total number of transplants between donors and patients in the set. Our model incorporates the possibility that some of the patients can undergo ABOi desensitization to increase compatibility with matched donors. The optimization model is iteratively used in a simulation framework which reproduces the dynamics of a KPD program over multiple runs. The output of the simulation is used to evaluate the increase in the number of transplants and in the number of matched highly sensitized patients when ABOi desensitization is integrated into a KPD. We used data from the National Kidney Registry and from the Alliance for Paired Donation consisting of a set of 827 incompatible pairs for a period of 2.5 years.

Results: The percentage of pairs in the pool who receive a transplant increases on average from 47% to 90% (st. dev. 0.02) when KPD is integrated with ABOi desensitization; the percentage of matched highly sensitized patients increases from 40% to 85% (st. dev. 0.03).

Conclusion: While further model development is necessary, our preliminary results reveal that integration of ABOi desensitization and KPD is a promising approach to improve access to a living donor renal transplant.

CITATION INFORMATION: Karami F., Nayebpour M., Gentili M., Koizumi N., Melancon K. Integration of Blood Type Incompatibility Desensitization Protocols into Kidney Paired Donation (KPD) Programs Am J Transplant. 2017;17 (suppl 3).

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