1
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Grande-Trillo A, Baliellas C, Lladó L, Casasnovas C, Franco-Baux JV, Gracia-Sánchez L, Gómez-Bravo MÁ, González-Vilatarsana E, Caballero-Gullón L, Echeverri E, González-Costello J. Transthyretin amyloidosis with cardiomyopathy after domino liver transplantation: Results of a cross-sectional study. Am J Transplant 2021; 21:372-381. [PMID: 32705768 DOI: 10.1111/ajt.16216] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2019] [Revised: 07/05/2020] [Accepted: 07/06/2020] [Indexed: 01/25/2023]
Abstract
Domino liver transplantation (DLT) has been used widely in patients with hereditary amyloid transthyretin (ATTR) amyloidosis. New-onset polyneuropathy in recipients of DLT has been reported, but there are few cases of cardiac involvement reported. We aimed to perform a cross-sectional study for ATTR amyloidosis with cardiomyopathy (ATTR-CM) in DLT recipients. We evaluated 23 living DLT recipients a median of 9 years since DLT at 2 referral centers with a systematic cardiac evaluation, including bone scintigraphy. Median age was 72 years, 91% had hypertension, 35% had diabetes mellitus, 67% had chronic renal failure, and 8 patients (35%) developed new-onset polyneuropathy. Only 13% had a normal electrocardiogram and a normal echocardiography, and most of them showed some conduction disturbance or increase in left ventricular wall thickness, but only 1 patient with a Glu89Lys mutation developed ATTR-CM diagnosed by bone scintigraphy and endomyocardial biopsy. None of the recipients of a DLT with Val30Met mutation showed cardiac involvement by bone scintigraphy. In conclusion, DLT from Val30Met donors seems to be safe regarding the development of ATTR-CM. Evaluation of cardiomyopathy in DLT recipients is challenging due to concomitant comorbidities and in this context, bone scintigraphy can be helpful to evaluate ATTR-CM.
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Affiliation(s)
- Antonio Grande-Trillo
- Advanced Heart Failure and Heart Transplant Unit, Virgen del Rocío University Hospital, Seville, Spain
| | - Carmen Baliellas
- Liver Transplant Unit, Department of Gastroenterology, IDIBELL, Bellvitge University Hospital, Barcelona, Spain.,Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Laura Lladó
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Liver Transplant Unit, Department of Surgery, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Carlos Casasnovas
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Neuromuscular Unit, Neurology Department, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Joaquín V Franco-Baux
- Department of Nuclear Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Laura Gracia-Sánchez
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Department of Nuclear Medicine, PET Unit-IDI, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - Miguel Á Gómez-Bravo
- Hepatobiliary and Liver Transplant Unit, General and Digestive Surgery Department, Virgen del Rocio University Hospital, Seville, Spain
| | - Emma González-Vilatarsana
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Liver Transplant Unit, Department of Surgery, IDIBELL, Bellvitge University Hospital, Barcelona, Spain
| | - Luis Caballero-Gullón
- Department of Nuclear Medicine, Virgen del Rocío University Hospital, Seville, Spain
| | - Eduardo Echeverri
- Advanced Heart Failure and Heart Transplant Unit, Heart Disease Institute, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
| | - José González-Costello
- Multidisciplinary Familial Amyloidosis Unit, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain.,Advanced Heart Failure and Heart Transplant Unit, Heart Disease Institute, Bellvitge University Hospital, Bellvitge Biomedical Research Institute, Barcelona, Spain
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2
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Kienzl‐Wagner K, Rosales A, Scheidl S, Giner T, Bösmüller C, Rudnicki M, Oberhuber R, Margreiter C, Soleiman A, Öfner D, Waldegger S, Schneeberger S. Successful management of recurrent focal segmental glomerulosclerosis. Am J Transplant 2018; 18:2818-2822. [PMID: 29962080 PMCID: PMC6220932 DOI: 10.1111/ajt.14998] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 06/20/2018] [Accepted: 06/22/2018] [Indexed: 01/25/2023]
Abstract
Primary focal segmental glomerulosclerosis (FSGS) recurs in up to 55% of patients after kidney transplantation. Herein we report the successful management of recurrent FSGS. A 5-year-old boy with primary FSGS received a deceased donor renal transplant. Immediate and fulminant recurrence of FSGS caused anuric graft failure that was resistant to plasmapheresis and rituximab. After exclusion of structural or immunologic damage to the kidney by repeated biopsies, the allograft was retrieved from the first recipient on day 27 and transplanted into a 52-year-old second recipient who had vascular nephropathy. Immediately after retransplantation, the allograft regained function with excellent graft function persistent now at 3 years after transplant. After 2 years on hemodialysis, the boy was listed for kidney retransplantation. To prevent FSGS recurrence, pretreatment with ofatumumab was performed. Nephrotic range proteinuria still occurred after the second transplantation, which responded, however, to daily plasma exchange in combination with ofatumumab. At 8 months after kidney retransplantation graft function is good. The clinical course supports the hypothesis of a circulating permeability factor in the pathogenesis of FSGS. Successful ofatumumab pretreatment implicates a key role of B cells. Herein we provide a description of successful management of kidney failure by FSGS, carefully avoiding waste of organs.
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Affiliation(s)
- Katrin Kienzl‐Wagner
- Department of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Alejandra Rosales
- Department of PediatricsMedical University of InnsbruckInnsbruckAustria
| | - Stefan Scheidl
- Department of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Thomas Giner
- Department of PediatricsMedical University of InnsbruckInnsbruckAustria
| | - Claudia Bösmüller
- Department of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Michael Rudnicki
- Department of Internal MedicineMedical University of InnsbruckInnsbruckAustria
| | - Rupert Oberhuber
- Department of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
| | - Christian Margreiter
- Department of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
| | | | - Dietmar Öfner
- Department of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
| | | | - Stefan Schneeberger
- Department of Visceral, Transplant and Thoracic SurgeryMedical University of InnsbruckInnsbruckAustria
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3
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Vollmar J, Schmid JC, Hoppe-Lotichius M, Barreiros AP, Azizi M, Emrich T, Geber C, Schad A, Weyer V, Otto G, Heise M, Mittler J, Birklein F, Lang H, Galle PR, Zimmermann T. Progression of transthyretin (TTR) amyloidosis in donors and recipients after domino liver transplantation-a prospective single-center cohort study. Transpl Int 2018; 31:1207-1215. [PMID: 30091268 DOI: 10.1111/tri.13326] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2018] [Revised: 03/30/2018] [Accepted: 07/27/2018] [Indexed: 11/30/2022]
Abstract
Liver transplantation (LT) is the first-line therapy in patients with transthyretin (TTR) amyloidosis and progressive familial amyloid polyneuropathy (FAP). Explanted organs from these patients can be used for domino liver transplantation (DLT). After DLT, de novo amyloidosis may develop in domino recipients (DR). Data were collected prospectively in a transplant database. Electroneurography by nerve conduction velocity (NCV), quantitative sensory testing, heart rate variability (HRV), sympathetic skin response, orthostatic reaction (tilt table test), transthoracic echocardiography, cardiac MRI and organ biopsy results were evaluated. The cohort included 24 FAP- (11 Val30Met, 13 nonVal30Met) and 23 DR-patients. DR symptoms referred to post-DLT only, while those of FAP patients were both pre- and post-transplantation. Symptoms of TTR-amyloidosis in Val30Met and Non-Val30Met patients pre- and post-LT were similarly distributed. Biopsy-proven de novo amyloidosis occurred in 4/23 DR after a mean observation of 10 years. Analysis for manifestations of amyloidosis only included patients with available 5-year follow-up data (n = 13 FAP, n = 12 DR). Compared to Val30Met FAP patients pre-LT, Val30Met DR patients had better NCV (P = 0.04) and HRV (P = 0.015). In the Non-Val30Met group no differences were found between DR and FAP patients pre-LT. TTR-amyloidosis symptoms showed no differences in FAP patients pre- and 5 years post-LT, irrespective of Val30Met status. In DR patients, de novo amyloidosis occurred earlier than expected. Therefore, recipients for DLT need to be carefully selected and followed.
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Affiliation(s)
- Johanna Vollmar
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Julia C Schmid
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Maria Hoppe-Lotichius
- Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Ana P Barreiros
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Deutsche Stiftung Organtransplantation, Mainz, Germany
| | - Mimoun Azizi
- Department of Neurology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tilman Emrich
- Department of Radiology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Christian Geber
- Department of Neurology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Arno Schad
- Institute of Pathology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Veronica Weyer
- Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Gerd Otto
- Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Michael Heise
- Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Jens Mittler
- Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Frank Birklein
- Department of Neurology, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Hauke Lang
- Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Department of General-, Abdominal- and Transplantation- Surgery, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Peter R Galle
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
| | - Tim Zimmermann
- I. Department of Internal Medicine, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany.,Interdisciplinary Transplant Center, University Medical Center, Johannes Gutenberg-University Mainz, Mainz, Germany
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4
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Geyer ED, Burrier C, Tumin D, Hayes D, Black SM, Washburn WK, Tobias JD. Outcomes of domino liver transplantation compared to deceased donor liver transplantation: a propensity-matching approach. Transpl Int 2018; 31:1200-1206. [PMID: 29907976 DOI: 10.1111/tri.13291] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2018] [Revised: 06/01/2018] [Accepted: 06/10/2018] [Indexed: 01/09/2023]
Abstract
Domino liver transplantation (DLT) utilizes the explanted liver of one liver transplant recipient as a donor graft in another patient. While there may be unique risks associated with DLT, it is unclear if DLT has less favorable long-term outcomes than deceased donor liver transplantation (DDLT). We used a propensity score matching approach to compare the outcomes of DLT recipients to DDLT recipients. The United Network for Organ Sharing (UNOS) registry was queried for patients undergoing DLT or DDLT in 2002-2016. Each DLT recipient was matched to a unique DDLT recipient to compare mortality and graft failure. There were 126 DLT and 62 835 DDLT recipients meeting inclusion criteria. After propensity score matching on recipient pre-transplant characteristics, 123 DLT cases were matched to DDLT controls from the same UNOS region. On stratified Cox proportional hazards regression, DLT incurred no increase in the hazard of mortality [hazard ratio (HR) = 1.4; 95% confidence interval (CI): 0.8, 2.7; P = 0.265] or graft failure (HR = 1.2; 95% CI: 0.7, 2.1; P = 0.556) compared to DDLT. Using a large national registry, a propensity-matched analysis found no increased risk of mortality or graft failure associated with DLT compared to DDLT.
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Affiliation(s)
- Emily D Geyer
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA
| | - Candice Burrier
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Dmitry Tumin
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Don Hayes
- Section of Pulmonary Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Respiratory and Critical Care Medicine, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Sylvester M Black
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - W Kenneth Washburn
- Department of Surgery, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Joseph D Tobias
- Department of Anesthesiology and Pain Medicine, Nationwide Children's Hospital, Columbus, OH, USA.,Department of Anesthesiology and Pain Medicine, The Ohio State University College of Medicine, Columbus, OH, USA.,Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH, USA
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5
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Cowan N, Gritsch HA, Nassiri N, Sinacore J, Veale J. Broken Chains and Reneging: A Review of 1748 Kidney Paired Donation Transplants. Am J Transplant 2017; 17:2451-2457. [PMID: 28489287 DOI: 10.1111/ajt.14343] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2016] [Revised: 04/27/2017] [Accepted: 04/29/2017] [Indexed: 01/25/2023]
Abstract
Concerns regarding the potential for broken chains and "reneges" within kidney paired donation (KPD) and its effect on chain length have been raised previously. Although these concerns have been tested in simulation studies, real-world data have yet to be evaluated. The purpose of this study was to evaluate the actual rate and causes of broken chains within a large KPD program. All patients undergoing renal transplantation through the National Kidney Registry from 2008 through May 2016 were included for analysis. Broken chains and loops were identified. A total of 344 chains and 78 loops were completed during the study period, yielding a total of 1748 transplants. Twenty broken chains and one broken loop were identified. The mean chain length (number of transplants) within broken chains was 4.8 compared with 4.6 of completed chains (p = 0.78). The most common causes of a broken chain were donor medical issues incurred while acting as a bridge donor (n = 8), donors electing not to proceed (n = 6), and kidneys being declined by the recipient surgeon (n = 4). All recipients involved in a broken chain subsequently received a transplant. Based on the results, broken chains are infrequent, are rarely due to lack of donor motivation, and have no significant impact on chain length.
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Affiliation(s)
- N Cowan
- Department of Urology, University of California - Los Angeles Medical Center, Los Angeles, CA
| | - H A Gritsch
- Department of Urology, University of California - Los Angeles Medical Center, Los Angeles, CA
| | - N Nassiri
- Department of Urology, University of Southern California, Los Angeles, CA
| | - J Sinacore
- Director of Education and Development, National Kidney Registry (NKR), Babylon, NY
| | - J Veale
- Department of Urology, University of California - Los Angeles Medical Center, Los Angeles, CA
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6
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Affiliation(s)
| | - J P Roberts
- Surgery, University of California at San Francisco, San Francisco, CA
| | - A B Leichtman
- Arbor Research Collaborative for Health, Ann Arbor, MI
| | - A E Roth
- Economics, Stanford University, Stanford, CA
| | - M A Rees
- Urology, University of Toledo Medical Center, Toledo, OH.,Alliance for Paired Donation, Maumee, OH
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7
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Bechiri MY, Eliahou L, Rouzet F, Fouret PJ, Antonini T, Samuel D, Adam R, Adams D, Slama MS, Algalarrondo V. Multimodality Imaging of Cardiac Transthyretin Amyloidosis 16 Years After a Domino Liver Transplantation. Am J Transplant 2016; 16:2208-2212. [PMID: 26880259 DOI: 10.1111/ajt.13755] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2015] [Revised: 01/13/2016] [Accepted: 02/05/2016] [Indexed: 01/26/2023]
Abstract
We report the case of a 62-year-old man hospitalized in May 2015 for symptomatic heart failure. His medical history included two liver transplantations. The first liver transplantation was performed in 1999 for a mixed alcoholic and hepatitis C-related cirrhosis and the patient received the liver of another patient with Val30Met transthyretin amyloidosis using the domino technique. In 2008, he complained of neuropathic pains and an iatrogenic-acquired transthyretin amyloidosis was diagnosed. On cardiac evaluation, amyloidosis was suspected. In March 2010, a second liver transplantation was performed with a deceased donor without complication. In May 2015, a first episode of symptomatic heart failure occurred and cardiac amyloidosis was investigated by a multimodality evaluation. Electrocardiogram, cardiac biomarkers, echocardiography, and cardiac MRI were in favor of the diagnosis of amyloidosis, whereas 99m Tc-dicarboxypropane diphosphonate scintigraphy was not. Endomyocardial biopsy finally confirmed the positive diagnosis of iatrogenic-acquired cardiac amyloidosis. This case is, to the best of our knowledge, the first to report biopsy-proven cardiac amyloidosis induced by domino liver transplantation and progressing heart failure in spite of retransplantation. The diagnostic modalities are discussed. This case should alert physicians to the cardiac risk in domino liver transplanted patients.
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Affiliation(s)
- M Y Bechiri
- AP-HP, Service de Cardiologie, Hôpital Béclère, Clamart, France
| | - L Eliahou
- AP-HP, Service de Cardiologie, Hôpital Béclère, Clamart, France
| | - F Rouzet
- AP-HP, Service de Médecine Nucléaire, Hôpital Bichat Claude Bernard, Paris, France.,INSERM U1148, Université Denis Diderot Paris 7, Paris, France
| | - P-J Fouret
- AP-HP, Service d'Anatomie Pathologique, Hôpital Pitié Salpêtrière, Paris, France
| | - T Antonini
- AP-HP, Centre Hépato-biliaire, Hôpital Paul Brousse, Villejuif, France.,INSERM U1193, Villejuif, France
| | - D Samuel
- AP-HP, Centre Hépato-biliaire, Hôpital Paul Brousse, Villejuif, France.,INSERM U1193, Villejuif, France.,Université Paris-Sud, Villejuif Le Kremlin-Bicêtre, France
| | - R Adam
- AP-HP, Centre Hépato-biliaire, Hôpital Paul Brousse, Villejuif, France.,INSERM U935, Villejuif, France.,Université Paris-Sud, Villejuif Le Kremlin-Bicêtre, France
| | - D Adams
- AP-HP, FILNEMUS, INSERM U1191, Service de Neurologie, Hôpital Bicêtre, le Kremlin Bicêtre, France.,Université Paris-Sud, Villejuif Le Kremlin-Bicêtre, France
| | - M S Slama
- AP-HP, Service de Cardiologie, Hôpital Béclère, Clamart, France.,Université Paris-Sud, Villejuif Le Kremlin-Bicêtre, France
| | - V Algalarrondo
- AP-HP, Service de Cardiologie, Hôpital Béclère, Clamart, France.,Université Paris-Sud, Villejuif Le Kremlin-Bicêtre, France.,INSERM U1180, Université Paris-Saclay, Chatenay Malabry, France
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8
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Bray M, Wang W, Song PXK, Leichtman AB, Rees MA, Ashby VB, Eikstadt R, Goulding A, Kalbfleisch JD. Planning for Uncertainty and Fallbacks Can Increase the Number of Transplants in a Kidney-Paired Donation Program. Am J Transplant 2015; 15:2636-45. [PMID: 26372837 PMCID: PMC5559873 DOI: 10.1111/ajt.13413] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2014] [Revised: 04/05/2015] [Accepted: 04/23/2015] [Indexed: 01/25/2023]
Abstract
A kidney-paired donation (KPD) pool consists of transplant candidates and their incompatible donors, along with nondirected donors (NDDs). In a match run, exchanges are arranged among pairs in the pool via cycles, as well as chains created from NDDs. A problem of importance is how to arrange cycles and chains to optimize the number of transplants. We outline and examine, through example and by simulation, four schemes for selecting potential matches in a realistic model of a KPD system; proposed schemes take account of probabilities that chosen transplants may not be completed as well as allowing for contingency plans when the optimal solution fails. Using data on candidate/donor pairs and NDDs from the Alliance for Paired Donation, the simulations extend over 8 match runs, with 30 pairs and 1 NDD added between each run. Schemes that incorporate uncertainties and fallbacks into the selection process yield substantially more transplants on average, increasing the number of transplants by as much as 40% compared to a standard selection scheme. The gain depends on the degree of uncertainty in the system. The proposed approaches can be easily implemented and provide substantial advantages over current KPD matching algorithms.
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Affiliation(s)
- M Bray
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - W Wang
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - P. X-K Song
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - A. B. Leichtman
- University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI,University of Michigan, Department of Medicine, Ann Arbor MI
| | - M. A. Rees
- University of Toledo Medical Center, Department of Urology, Toledo, OH,Alliance for Paired Donation, Inc., Maumee, OH
| | - V. B. Ashby
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - R. Eikstadt
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
| | - A. Goulding
- University of Michigan, School of Information, Ann Arbor, MI
| | - J. D. Kalbfleisch
- University of Michigan, Department of Biostatistics, Ann Arbor, MI,University of Michigan, Kidney Epidemiology and Cost Center; Ann Arbor, MI
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