Deceased donor chain initiating kidneys might increase annual transplants
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Simulations revealed that using deceased donor kidneys in transplant chains could increase the number of transplants by 290 a year, according to data published in the Kidney International Reports.
Further, investigators noted that using deceased donors (DD) can increase transplantations for blood type O kidney-paired donation (KPD) candidates.
“Rather than generating one transplant by directly donating to a candidate on the waitlist, DD could achieve additional transplants by donating to a candidate in a kidney-paired donation (KPD) pool, thereby, initiating a chain that ends with a living donor (LD) donating to a candidate on the waitlist,” Wen Wang, PhD, a research fellow from the department of biostatistics at the University of Michigan, and colleagues wrote. “Following previous work in this field, three natural questions are whether longer DD initiated chains can: 1) produce more transplants; 2) reduce number of deceased donor chain initiating kidneys (DD-CIKs); 3) balance the number of blood type O DD-CIKs and LDs returning to the waitlist.”
Wang and colleagues simulated strategies to allow DD to initiate KPD chains based on 2016 and 2017 U.S. DD and waitlist data. The KDP pools, however, were simulated with LDs and high proportions of highly sensitized and/or blood type O candidates.
Using the simulations, researchers tested six strategies designed with a “view to ease of implementation, and in each case fewer than 3% of the total national number of DD kidneys are allocated to the KPD pool.”
Analyses revealed longer DD initiated chains increased the number of KPD transplants by up to 5% and lowered the number of DDs granted to the KPD pool by 25% compared with shorter DD-initiated KPD chains. According to the study, allocating less than 3% of DD to start KPD chains could lead to 290 more kidney transplants a year.
“In conclusion, this study simulates the use of DD-CIKs and suggests several new strategies that can further increase the total number of kidney transplants, the number of blood type O transplants, the number of transplants from within the KPD pool, and the number of transplants for candidates on the DD waitlist,” Wang and colleagues wrote. “These strategies would also make available LD kidneys to candidates who are waitlisted for DD transplantation, but who otherwise are without such access.”
Researchers noted they are developing a more comprehensive model to simulate the impact of policy changes on waitlist candidates including blood type O, individuals from underrepresented groups or members of different candidate groups.
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