Introduction: Our national kidney-exchange allocation program is established in 2004. Though kidney-exchange is intertwined with (un)specified donation and domino-paired procedures, the latter still operates by hand and on a local level. Desensitisation results are better for transplants with current negative compared to current positive CDC crossmatches (CDC-XM). In our laboratory a MFI<8000 generally is associated with a negative CDC-XM. A computerised allocation program was developed to integrate these programs to increase efficiency and find matches with negative current CDC-XM for highly sensitised patients (KEPmatch). Methods: A simulation was carried out including all local waitlisted patients, (un)specified donors and HLA- or ABO-incompatible (ABOi) pairs that participated in our programs in 2015. With KEPmatch 4 runs were simulated with 3 months intervals. For 14 highly sensitised patients (PRA>85%) ABOi and current unacceptables with MFI<8000 were allowed . Results: In reality in 2015, there were 3 transplants via kidney-exchange program. Our experienced matcher included 23 (un)specified donors consecutively in time: 9 (un)specified donors initiated chains (7 with 1 and 2 with 2 incompatible pairs), 14 donated to the waitlist. In total 37 transplantations were carried out, none of the highly sensitised patients were matched. In the 4 KEPmatch runs respectively 6, 5, 5 and 7 (un)specified donors were included. 10 (un)specified donors were matched to the waitlist, 13 (un)specified donors initiated chains ( 9 with 1 incompatible pair, 4 with 2 pairs). There were 2 kidney-exchange chains with 2 incompatible pairs, 1 kidney-exchange chain with 3 incompatible pairs. KEPmatch found 44 ABO and HLA compatible matches: 20% more than in reality. On top of that 3 HLAi matches were found (anti donor MFI<8000) of whom 1 also ABOi. For these patients desensitisation is still indicated but success rate is high because of expected current negative CDC-XM. Conclusion: Timing of inclusion of (un)specified donors and computer allocation to integrate programs has led to 20% more ABO and HLA compatible matches. Besides for 3 HLA incompatible pairs matches were found that offered better chances in our desensitisation program.

CITATION INFORMATION: de Klerk M, Kal J, Middel S, van de Wetering J, Kho M, Betjes M, Zuidema W, Roelen D, Glorie K, Roodnat J. Integration of Kidney-Exchange, (Un)Specified Living Donor Transplantation, ABO Incompatible and Desensitisation Programs in a Computerized Allocation Program: A Simulation. Am J Transplant. 2017;17 (suppl 3).

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