Optimal Integration of Kidney Exchange Programs with Antibody Reduction Therapy to Increase Successful Transplant in Difficult to Match Recipients.
1Surgery, George Washington University Hospital, Washington, DC
2Public Policy, George Mason Univ, Arlington, VA
3Operations Research, University of Louisville, Louisville, KY
4Surgery, Howard University Hospital, Washington, DC.
Meeting: 2016 American Transplant Congress
Abstract number: D183
Keywords: Allocation, Antibodies, Kidney transplantation
Session Information
Date: Tuesday, June 14, 2016
Session Name: Poster Session D: Organizational and Operational Aspects of Transplantation
Session Time: 6:00pm-7:00pm
Presentation Time: 6:00pm-7:00pm
Location: Halls C&D
Kidney paired donation (KPD) allows incompatible pairs to exchange kidneys with other incompatible pairs. However, evidence suggests there stills exist barriers to KPD utilization, especially among difficult-to-match transplant candidates and positive actual or virtual cross-matches. Optimization models to maximize the number of transplants in KPD setting have been developed. However, these KPD matching optimization models and algorithms look for the best possible match among incompatible pairs without considering the possibility of combining KPD and desensitization, resulting in less than 15% of highly sensitized patients finding a compatible pair in a match run.
Our mathematical approach overcomes such limitations. We use optimization and simulation analyses to optimally integrate antibody reduction therapy in KPD match runs to increase the overall number of transplants and, simultaneously, to increase the chances of finding a potential successful matching involving difficult-to-match recipients. Specifically, the proposed mathematical model matches incompatible pairs taking into consideration the possibility that some of the recipients could undergo a desensitization protocol to improve compatibility with the matched donor. As a preliminary analysis, we generated 93 different snapshots of pools with different numbers of donor/recipient pairs and compatibilities using UNOS KPD data. Our preliminary model indicated that the total number of transplants in the KPD pool could go up approximately by 50% if desensitizations were performed to increase the number of matches by 1%. The outputs of the model could potentially provide guidelines regarding which incompatible pairs to match and which patients to treat with antibody reduction therapy.
CITATION INFORMATION: Melancon K, Koizumi N, Gentili M, Callender C. Optimal Integration of Kidney Exchange Programs with Antibody Reduction Therapy to Increase Successful Transplant in Difficult to Match Recipients. Am J Transplant. 2016;16 (suppl 3).
To cite this abstract in AMA style:
Melancon K, Koizumi N, Gentili M, Callender C. Optimal Integration of Kidney Exchange Programs with Antibody Reduction Therapy to Increase Successful Transplant in Difficult to Match Recipients. [abstract]. Am J Transplant. 2016; 16 (suppl 3). https://atcmeetingabstracts.com/abstract/optimal-integration-of-kidney-exchange-programs-with-antibody-reduction-therapy-to-increase-successful-transplant-in-difficult-to-match-recipients/. Accessed June 4, 2020.« Back to 2016 American Transplant Congress