Transcript Slides.

Reasons for Match Offer Refusals and Efforts to
Reduce them in the OPTN/UNOS Kidney Paired
Donation Pilot Program (KPDPP)
Ruthanne Leishman, MPH RN UNOS; Darren Stewart, MS, UNOS;
Anna Kucheryavaya, MS, UNOS; Liz Robbins Callahan, Esq, UNOS
Tuomas Sandholm, PhD, Carnegie Mellon University; Mark Aeder, MD, University
Hospital Case Med Center
ATC 2015
Philadelphia, PA
[email protected]
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The Joint Annual Congress of the American Society of Transplant Surgeons and The American Society of Transplantation
Ruthanne Leishman RN, MPH
OPTN KPDPP Program Manager
UNOS, Richmond, VA, USA
I have no financial relationships to disclose within the past 12 months relevant to
my presentation
AND
My presentation does not include discussion of off-label or investigational use
I do not intend to reference unlabeled/unapproved uses of drugs or products in
my presentation.
Acknowledgments
This analysis reflects work performed on behalf of and in
conjunction with the OPTN Kidney Transplantation
Committee and the Kidney Paired Donation Work Group.
This work was supported wholly or in part by Health
Resources and Services Administration contract 234-2005370011C. The content is the responsibility of the authors alone
and does not necessarily reflect the views or policies of the
Department of Health and Human Services, nor does mention
of trade names, commercial products, or organizations imply
endorsement by the U.S. Government.
Background
 The
OPTN KPDPP was launched in 2010
 Algorithms
search for 2-way/3-way/chain exchanges
 The
number of pairs entered, matches found, and
transplants continues to increase
 Match
Success Rate ~8.3%
Match Success Rate = Transplants/Matches offered
 Strategies
for improving Match Success Rate
Cumulative Transplants Facilitated through April 2015
160
140
140
120
100
79
80
60
40
27
17
20
2
0
Match Success Rates
Sept 2011 - Sept 2014 Rolling 12-month average
(All Matches Resulting in Tx Including Repairs / All Matches Identified by Algorithm)
16.0%
14.0%
12.0%
10.0%
8.0%
6.0%
4.0%
2.0%
0.0%
15.2%
14.8%
12.6%
13.0%
9.4%
9.0%
6.3%
7.1%
9.6%
12.4%
10.6%
8.3%
5.4%
3.5%
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12 MONTH ROLLING AVERAGE%
OVERALL RATE
Methods
 OPTN
data from Jan 2014 - Sep 2014
 Analyzed
332 match offers that did not result in transplant
 Multiple
refusal reasons for individual match offer
percentage not equal to100%
 Repaired
matches were excluded
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Types of match declines
2-way exchange: 2 matches
Donor 1
Candidate1
Blood type A
Blood type B
Donor 2
Blood type B
Candidate 2
Blood type A
1. Match 1
Direct decline
2. Match 2 Indirect decline
‘Accepted but exchange
fell through’
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Results
 Indirect
 Direct
declines: 52% (n=172)
declines: 48% (n=160)
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Categories of Direct Declines
34.4%
Donor-related
32.6%
Crossmatch-related
21.9%
Candidate-related
Other
13.8%
Match Runs: Jan-Sep 2014
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Crossmatch-related refusal reasons
Match Runs: Jan-Sep 2014 (n=52)
34.6%
65.4%
Positive Virtual
Crossmatch
Positive Physical
Crossmatch
Virtual +crossmatch can be due to:
• Non-required donor antigens not
entered
• Non-required donor antigens not
screened
• Candidate unacceptable antigens
not entered
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Crossmatch decline follow up
Match Runs: Jan-Sep 2014
Percentage of crossmatch related declines with and
without follow up
38.5%
Percentage of follow up related to
DP/DQ versus all other unacceptables
40.0%
61.5%
60.0%
Follow up
No follow up
DP/DQ unacceptables
Others
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Donor-related refusal reasons
Match Runs: Jan-Sep 2014 (n= 60)
Matched donor age
35.3%
Matched donor medical history
31.4%
Matched donor height/weight/BMI
13.7%
Paired donor declined to donate
9.8%
Matched donor vessels
9.8%
Other matched donor related reason
17.6%
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Candidate-related refusal reasons
Match Runs: Jan-Sep 2014 (n=37)
Cand. in other KPD program pending match
43.2%
Cand. transplanted or offer in progress
32.4%
Candidate ill, unsuitable, or unavailable
Other candidate related reason
16.2%
8.1%
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Strategies for improving Match Success Rate
Donor Specific Antigen related
 DQA screened
 New
as of April 29th
Histocompatibility requirements policy
Approved, pending programming
 Donor DPB, DQA and DQB required
 Repeat candidate antibody screening and update every 90
days

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Strategies for improving Match Success Rate
Donor and Candidate related
 Candidate

and Donor choices questions
Allows entry of maximum donor age, BMI and other factors
 Donor
pre-select option
 Donor
pre-select required on candidates with CPRA 90%+
 Easy
inactivation/reactivation of candidate/donor pairs
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Strategies for improving Match Success Rate
Overall
 Changes
to optimization algorithm
Such as failure aware matching: Dickerson, Procaccia &
Sandholm EC-13] and the FUTUREMATCH framework [Dickerson
& Sandholm AAAI-15]
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Summary
 Failed exchanges due to:
Donor specific antibodies
 Donor age, medical history, or size
 A candidate having another transplant opportunity

 Strategies
for improving Match Success Rate
Policies and tools to increase efficiency – more matches
move forward
 Individualized program support

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Thank you!
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