Simulation Model for Cytomegalovirus Matching in Deceased Donor Kidney Allocation System in the U.S.

B. Tanriover¹, V. K. Ariyamuthu¹, T. Zangeneh², M. M. Al Obaidi², Y. Ulukus³, M. A. Ergun³, B. Sandikci⁴

¹Department of Medicine / Nephrology, University of Arizona, COM Tucson, Tucson, AZ, ²Department of Medicine / Infectious Disease, University of Arizona, COM Tucson, Tucson, AZ, ³Operations Management, Istanbul Technical University, Istanbul, Turkey, ⁴Operations Management, University of Chicago, Chicago, IL

Meeting: 2021 American Transplant Congress

Abstract number: LB 75

Keywords: Allocation, Cadaveric organs, Cytomeglovirus, Kidney transplantation

Topic: Clinical Science » Kidney » Kidney Deceased Donor Allocation

Session Information

Session Name: Kidney Deceased Donor Allocation

Session Type: Poster Abstract

Session Date & Time: None. Available on demand.

Location: Virtual

*Purpose: The prevalence of positive and negative cytomegalovirus (CMV) serology among transplant recipients and donors are approximately 60-65% and 30-35%, respectively. CMV mismatch, donor-positive/recipient-negative status (D+/R-), negatively impacts post-transplant outcomes, including developing CMV disease, triggering acute rejection, increasing hospitalizations, and mortality. The current kidney allocation system (KAS) does not take into consideration CMV matching (D+/R+ and D-/R-).

*Methods: We developed a discrete event KAS simulation model, in which arrivals of organs and patients, status updates for candidates (active/inactive status, removal from the waiting list due to death or other reasons), transplant events, and discards are linked to an actual transplant database obtained from the Organ Procurement and Transplant Network between 2015 and 2018. We compared the current KAS policy to the simulated CMV matching policy with different calculated PRA (cPRA) thresholds (0, 50, 85, 95, 98, 99, 100%). We reported three years of aggregate results.

*Results: Compared to the current KAS policy (D+/R-: 18.83%), implementing the CMV matching policy significantly decreased D+/R- kidney allocation depending on cPRA thresholds (cPRA 0%: 7.94%, cPRA 50%: 4.80%, and cPRA 100%: 1.34%). With higher cPRA thresholds, the wait-listed time slightly decreased, the KPDI slightly increased for the CMV R- group, and no changes were observed for CMV R+ group. In the D-/R- group, the numbers of transplants were marginally increased, and the discards were decreased (from 15% to 12%). The overall transplant rate increased from 12.6% to 12.8% per 100 patient-years. One-year overall allograft survival did not considerably change with CMV matching.

*Conclusions: CMV matching policy at higher cPRA threshold levels provides the highest positive impact on measured outcomes while not perturbing equity or utility in KAS.

To cite this abstract in AMA style:

Tanriover B, Ariyamuthu VK, Zangeneh T, Obaidi MMAl, Ulukus Y, Ergun MA, Sandikci B. Simulation Model for Cytomegalovirus Matching in Deceased Donor Kidney Allocation System in the U.S. [abstract]. Am J Transplant. 2021; 21 (suppl 3). https://atcmeetingabstracts.com/abstract/simulation-model-for-cytomegalovirus-matching-in-deceased-donor-kidney-allocation-system-in-the-u-s/. Accessed May 16, 2025.

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