Computer-Aided Altruistic Unbalanced Paired Kidney Exchange: A Pilot Software.

Abstract

Paired kidney exchange (PKE) is a proposed solution to antibody barriers to direct donation, avoiding the risks and costs associated with desensitization protocols. Our Centre performed the first PKE in Italy in 2005. Unfortunately, balanced PKE programs invariably leads to stagnation of blood group O recipients. In order to solve them, inclusion of compatible pairs in PKE programs has been implemented, leading to so-called altruistic unbalanced PKE (auPKE) programs. The increasing complexity of multi-centre auPKE programs demands a dedicated software and an appropriate algorithm to ensure fairness and use of optimal solutions. We report here the design and beta-testing of “Transplant manager”, the first software dedicate to solving single patients or entire pools using balanced or auPKE programs. The whole set of parameters taken into account to accept and rank solutions can be customized by the end-user.Figure: No Caption available.The pair universus is divided into 3 subgroups: perfectly compatible pairs, suboptimally compatible pairs (those who can gain something from the donor swap in terms of donor age, DSA level, anthropometric match or predicted renal function), and incompatible pairs. The software also automates calculation of several immunological parameters (HLA matching, match probability within the pool, calculated PRA, and estimated renal function and graft survival according to UNOS-validated nomograms. Our project has received the 2013 Julia Bodmer Award by the European Federation of Immunogenetics, and is currently under consideration for endorsement by the South Transplant Alliance.