Historical Matching Strategies in Kidney Paired Donation: The 7‐Year Evolution of a Web‐Based Virtual Matching System. Issue 10 (26th May 2015)

• Record Type: Journal Article
• Authors: Fumo, D. E.; Kapoor, V.; Reece, L. J.; Stepkowski, S. M.; Kopke, J. E.; Rees, S. E.; Smith, C.; Roth, A. E.; Leichtman, A. B.; Rees, M. A.
• Is Part Of: American journal of transplantation. Volume 15:Issue 10(2015:Oct.)
• Page Start: 2646
• Page End: 2654
• Publication Date: 2015-05-26
• Subjects: kidney transplantation/nephrology -- histocompatibility; Transplantation of organs, tissues, etc -- Periodicals; 617.95
• DOI: 10.1111/ajt.13337
• Languages: English
• ISSNs: 1600-6135

Abstract

Abstract : Failure to convert computer‐identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from "offers" to completed transplants. Offers were divided into individual segments called 1‐way transplants in order to calculate success rates. From 2007 to 2014, the Alliance for Paired Donation performed 243 transplants, 31 in collaboration with other KPD registries and 194 independently. Sixty‐one of 194 independent transplants (31.4%) occurred via cycles, while the remaining 133 (68.6%) resulted from nonsimultaneous extended altruistic donor (NEAD) chains. Thirteen of 35 (37.1%) NEAD chains with at least three NEAD segments accounted for 68% of chain transplants (8.6 tx/chain). The "offer" and 1‐way success rates were 21.9 and 15.5%, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software: positive laboratory crossmatch (28%), transplant center declined donor (17%) and pair transplanted outside APD (14%). Performing a root cause analysis on failures in moving from offer to transplant has allowed the APD to improve protocols and software. These changes have improved the success rate and the number of transplants performed per year. Abstract : This analysis of the reasons for failure to progress from computer‐generated kidney exchanges to actual transplants in a multi‐center kidney paired donation program identifies obstacles in matching incompatible donor/recipient pairs and discusses implications for a national kidney paired donation program. See related articles from Gentry and Segev on page2539, Bray et al on page2636, and Flechner et al on page2712 .