TY - JOUR
T1 - Novel Allocation Strategies Can Boost Kidney Exchange Programs
T2 - A Monte Carlo Simulation
AU - Klaassen, Mattheüs F
AU - de Klerk, Marry
AU - Baas, Marije C
AU - Bouwsma, Hanneke
AU - Bungener, Laura B
AU - Christiaans, Maarten H L
AU - Dollevoet, Twan
AU - Glorie, Kristiaan
AU - Heidt, Sebastiaan
AU - Hemke, Aline C
AU - de Jong, Margriet F C
AU - Kal-van Gestel, Judith A
AU - Kho, Marcia M L
AU - Langereis, Jeroen D
AU - van der Pant, Karlijn A M I
AU - Ranzijn, Claudia M
AU - Roelen, Dave L
AU - Spierings, Eric
AU - Voorter, Christina E M
AU - van de Wetering, Jacqueline
AU - van Zuilen, Arjan D
AU - Roodnat, Joke I
AU - de Weerd, Annelies E
N1 - Publisher Copyright:
Copyright © 2026 Klaassen, de Klerk, Baas, Bouwsma, Bungener, Christiaans, Dollevoet, Glorie, Heidt, Hemke, de Jong, Kal-van Gestel, Kho, Langereis, van der Pant, Ranzijn, Roelen, Spierings, Voorter, van de Wetering, van Zuilen, Roodnat and de Weerd.
PY - 2026/3/4
Y1 - 2026/3/4
N2 - Kidney exchange programs (KEPs) enhance access to living donor kidney transplantation. Nonetheless, transplant rates in KEP remain low for highly immunized and blood type O patients. In the Netherlands, a novel allocation algorithm is being implemented, allowing ABO-incompatible matching for long waiting patients, next to prioritization and 'low-level' HLA-incompatible matching for selected highly immunized patients. We simulated this novel algorithm along with additional scenarios, by using a retrospective, 6-year cohort of Dutch KEP. For each scenario, 30 simulations were repeated with Monte Carlo technique. The novel algorithm increased median KEP transplant rate for incompatible pairs (53% versus 44%, p < 0.001) and for difficult-to-match subgroups. HLA-incompatible matching increased transplant rate for selected highly immunized patients significantly, while participation with multiple donors per recipient did not. In additional simulations, including all non-KEP unspecified donors (n = 150) for local KEP participation increased transplant rate for incompatible pairs up to 64% (p < 0.001). Simulating additional KEP participation by compatible pairs (n = 149), on the condition a KEP match should have fewer HLA mismatches, resulted in 58% being matched in KEP. In conclusion, differential matching algorithms can boost KEP transplant rates, allowing incompatible matching for difficult-to-match subgroups, facilitating participation of unspecified donors, and optimizing the HLA matching of compatible pairs.
AB - Kidney exchange programs (KEPs) enhance access to living donor kidney transplantation. Nonetheless, transplant rates in KEP remain low for highly immunized and blood type O patients. In the Netherlands, a novel allocation algorithm is being implemented, allowing ABO-incompatible matching for long waiting patients, next to prioritization and 'low-level' HLA-incompatible matching for selected highly immunized patients. We simulated this novel algorithm along with additional scenarios, by using a retrospective, 6-year cohort of Dutch KEP. For each scenario, 30 simulations were repeated with Monte Carlo technique. The novel algorithm increased median KEP transplant rate for incompatible pairs (53% versus 44%, p < 0.001) and for difficult-to-match subgroups. HLA-incompatible matching increased transplant rate for selected highly immunized patients significantly, while participation with multiple donors per recipient did not. In additional simulations, including all non-KEP unspecified donors (n = 150) for local KEP participation increased transplant rate for incompatible pairs up to 64% (p < 0.001). Simulating additional KEP participation by compatible pairs (n = 149), on the condition a KEP match should have fewer HLA mismatches, resulted in 58% being matched in KEP. In conclusion, differential matching algorithms can boost KEP transplant rates, allowing incompatible matching for difficult-to-match subgroups, facilitating participation of unspecified donors, and optimizing the HLA matching of compatible pairs.
KW - ABO Blood-Group System
KW - Algorithms
KW - Blood Group Incompatibility
KW - Female
KW - HLA Antigens/immunology
KW - Histocompatibility Testing
KW - Humans
KW - Kidney Transplantation/methods
KW - Living Donors
KW - Male
KW - Monte Carlo Method
KW - Netherlands
KW - Retrospective Studies
KW - Tissue and Organ Procurement/methods
U2 - 10.3389/ti.2026.15423
DO - 10.3389/ti.2026.15423
M3 - Article
C2 - 41858495
SN - 0934-0874
VL - 39
JO - Transplant international : official journal of the European Society for Organ Transplantation
JF - Transplant international : official journal of the European Society for Organ Transplantation
M1 - 15423
ER -