Bi-organ paired exchange—Sentinel case of a liver-kidney swap

Torres, Ana‐Marie; Wong, F; Pearson, Sophie; Weinberg, Sandy; Roberts, John P.; Ascher, Nancy L.; Freise, Chris E.; Lee, Brian K.

doi:10.1111/ajt.15386

Cited by 8 publications

(5 citation statements)

References 17 publications

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“…For example, if a donor from pair 1 is ruled out from donating his/her kidney due to any reason specific to the kidney can still donate his/her liver to another pair 2 whose recipient needs a liver transplant and the donor of the pair 2 who has been rejected for liver donation donates his/her kidney to pair 1. First such case has been published by Torres et al [48] (Fig. 4).…”

Section: Newer Trends In Paired Kidney Exchangementioning

confidence: 95%

Paired kidney exchange transplantation – pushing the boundaries

Kher

Jha

2020

Transpl Int

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Summary The scarcity of living organ donors makes it imperative to develop newer innovations to optimize and maximize the utilization of the available pool. ABO and HLA sensitization are important immunological barriers in renal transplant and can potentially lead to rejection of almost one‐third of the willing living donors. Paired kidney exchange (PKE) is a rapidly growing method used to overcome these barriers and has grown in popularity over the last three decades since its introduction in 1986. Evolution of the matching strategies and use of complex algorithms has led to increase in the number of possible matches thereby benefiting multiple recipients. The use of altruistic donors and compatible pairs has also helped in increasing the possible exchanges. This review provides an in‐depth analysis of the evolution, the present global scenario, and the future of PKE. It also discusses the recent trends of advanced donation, trans‐organ paired exchange and global kidney exchange and the associated ethical concerns.

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Section: Newer Trends In Paired Kidney Exchangementioning

confidence: 95%

Paired kidney exchange transplantation – pushing the boundaries

Kher

Jha

2020

Transpl Int

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“…It might be used, for example, when a living kidney donor who is not eligible for renal donation but can donate his/her liver to a liver recipient of a pair whose donor is ruled out from liver donation but is suitable for kidney donation. Torres, et al published the first case of trans-organ exchange, attracting many criticisms related to the surgical risk of donation that is very different for different organs ( 46 ).…”

Section: The Place Of Kidney Exchange Programs For Highly Sensitized ...mentioning

confidence: 99%

European Guideline for the Management of Kidney Transplant Patients With HLA Antibodies: By the European Society for Organ Transplantation Working Group

Mamode

Bestard

Claas³

et al. 2022

Transpl Int

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This guideline, from a European Society of Organ Transplantation (ESOT) working group, concerns the management of kidney transplant patients with HLA antibodies. Sensitization should be defined using a virtual parameter such as calculated Reaction Frequency (cRF), which assesses HLA antibodies derived from the actual organ donor population. Highly sensitized patients should be prioritized in kidney allocation schemes and linking allocation schemes may increase opportunities. The use of the ENGAGE 5 ((Bestard et al., Transpl Int, 2021, 34: 1005–1018) system and online calculators for assessing risk is recommended. The Eurotransplant Acceptable Mismatch program should be extended. If strategies for finding a compatible kidney are very unlikely to yield a transplant, desensitization may be considered and should be performed with plasma exchange or immunoadsorption, supplemented with IViG and/or anti-CD20 antibody. Newer therapies, such as imlifidase, may offer alternatives. Few studies compare HLA incompatible transplantation with remaining on the waiting list, and comparisons of morbidity or quality of life do not exist. Kidney paired exchange programs (KEP) should be more widely used and should include unspecified and deceased donors, as well as compatible living donor pairs. The use of a KEP is preferred to desensitization, but highly sensitized patients should not be left on a KEP list indefinitely if the option of a direct incompatible transplant exists.

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“…Kidney exchanges save lives and are broadly viewed as beneficial to humanity; however, as in many resourceconstrained settings, decision-makers must make morallyladen decisions when designing the objective functions, constraints, and other modeling concerns that increasingly run modern exchange programs. The economics, AI, operations research, bioethics, medical, and legal communities have long discussed the moral implications of different approaches to the allocation of organs (see, e.g., Cohen 1989), including kidney exchanges (see, e.g., Ross et al 1997;Minerva, Savulescu, and Singer 2019;Torres et al 2019). Broadly speaking, our proposed work falls into the category of creating a more general, and thus potentially more powerful, model for the exchange of organs, and thus may come with many of the same positive and negative potential ethical impacts.…”

Section: Ethical Impactmentioning

confidence: 99%

Optimal Kidney Exchange with Immunosuppressants

Aziz

Cseh

Dickerson

et al. 2021

AAAI

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Algorithms for exchange of kidneys is one of the key successful applications in market design, artificial intelligence, and operations research. Potent immunosuppressant drugs suppress the body's ability to reject a transplanted organ up to the point that a transplant across blood- or tissue-type incompatibility becomes possible. In contrast to the standard kidney exchange problem, we consider a setting that also involves the decision about which recipients receive from the limited supply of immunosuppressants that make them compatible with originally incompatible kidneys. We firstly present a general computational framework to model this problem. Our main contribution is a range of efficient algorithms that provide flexibility in terms of meeting meaningful objectives. Motivated by the current reality of kidney exchanges using sophisticated mathematical-programming-based clearing algorithms, we then present a general but scalable approach to optimal clearing with immunosuppression; we validate our approach on realistic data from a large fielded exchange.

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Bi-organ paired exchange—Sentinel case of a liver-kidney swap

Cited by 8 publications

References 17 publications

Paired kidney exchange transplantation – pushing the boundaries

Paired kidney exchange transplantation – pushing the boundaries

European Guideline for the Management of Kidney Transplant Patients With HLA Antibodies: By the European Society for Organ Transplantation Working Group

Optimal Kidney Exchange with Immunosuppressants

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