Kidney exchange collaboration between Stanford and APKD

 I recently had occasion to review the long collaboration between my Stanford colleagues and Mike Rees and the Alliance for Paired Kidney Donation. It turns out that, together with other coauthors, Mike and his APKD colleagues have written well over a dozen papers with me and my colleagues at Stanford.  (My own collaboration with Mike and APKD goes back to when Itai Ashlagi and I were still in Boston, where my earliest papers on kidney exchange were with  Tayfun Sönmez and Utku Ünver, and with Frank Delmonico and his colleagues at the New England Program for Kidney Exchange.)

Here's the list I came up with, probably not exhaustive:

Mike Rees/APKD collaborations with Stanford scholars (Ashlagi, Melcher, Roth, Somaini)

 1. Rees, Michael A., Jonathan E. Kopke, Ronald P. Pelletier, Dorry L. Segev, Matthew E. Rutter, Alfredo J. Fabrega, Jeffrey Rogers, Oleh G. Pankewycz, Janet Hiller, Alvin E. Roth, Tuomas Sandholm, Utku Ünver, and Robert A. Montgomery, “A Non-Simultaneous Extended Altruistic Donor Chain,” New England Journal of Medicine, 360;11, March 12, 2009, 1096-1101. https://www.nejm.org/doi/full/10.1056/NEJMoa0803645

2.     Ashlagi, Itai, Duncan S. Gilchrist, Alvin E. Roth, and Michael A. Rees, “Nonsimultaneous Chains and Dominos in Kidney Paired Donation – Revisited,” American Journal of Transplantation, 11, 5, May 2011, 984-994 http://www.stanford.edu/~alroth/papers/Nonsimultaneous%20Chains%20AJT%202011.pdf

3.     Ashlagi, Itai, Duncan S. Gilchrist, Alvin E. Roth, and Michael A. Rees, “NEAD Chains in Transplantation,” American Journal of Transplantation, December 2011; 11: 2780–2781. http://web.stanford.edu/~iashlagi/papers/NeadChains2.pdf

4.     Wallis, C. Bradley, Kannan P. Samy, Alvin E. Roth, and Michael A. Rees, “Kidney Paired Donation,” Nephrology Dialysis Transplantation, July 2011, 26 (7): 2091-2099 (published online March 31, 2011; doi: 10.1093/ndt/gfr155, https://academic.oup.com/ndt/article/26/7/2091/1896342/Kidney-paired-donation

5.     Rees, Michael A.,  Mark A. Schnitzler, Edward Zavala, James A. Cutler,  Alvin E. Roth, F. Dennis Irwin, Stephen W. Crawford,and Alan B.  Leichtman, “Call to Develop a Standard Acquisition Charge Model for Kidney Paired Donation,” American Journal of Transplantation, 2012, 12, 6 (June), 1392-1397. (published online 9 April 2012 http://onlinelibrary.wiley.com/doi/10.1111/j.1600-6143.2012.04034.x/abstract )

6.     Anderson, Ross, Itai Ashlagi, David Gamarnik, Michael Rees, Alvin E. Roth, Tayfun Sönmez and M. Utku Ünver, " Kidney Exchange and the Alliance for Paired Donation: Operations Research Changes the Way Kidneys are Transplanted," Edelman Award Competition, Interfaces, 2015, 45(1), pp. 26–42. http://pubsonline.informs.org/doi/pdf/10.1287/inte.2014.0766

7.     Fumo, D.E., V. Kapoor, L.J. Reece, S.M. Stepkowski,J.E. Kopke, S.E. Rees, C. Smith, A.E. Roth, A.B. Leichtman, M.A. Rees, “Improving matching strategies in kidney paired donation: the 7-year evolution of a web based virtual matching system,” American Journal of Transplantation, October 2015, 15(10), 2646-2654 http://onlinelibrary.wiley.com/enhanced/doi/10.1111/ajt.13337/ (designated one of 10 “best of AJT 2015”)

8.     Melcher, Marc L., John P. Roberts, Alan B. Leichtman, Alvin E. Roth, and Michael A. Rees, “Utilization of Deceased Donor Kidneys to Initiate Living Donor Chains,” American Journal of Transplantation, 16, 5, May 2016, 1367–1370. http://onlinelibrary.wiley.com/doi/10.1111/ajt.13740/full

9.     Michael A. Rees, Ty B. Dunn, Christian S. Kuhr, Christopher L. Marsh, Jeffrey Rogers, Susan E. Rees, Alejandra Cicero, Laurie J. Reece, Alvin E. Roth, Obi Ekwenna, David E. Fumo, Kimberly D. Krawiec, Jonathan E. Kopke, Samay Jain, Miguel Tan and Siegfredo R. Paloyo, “Kidney Exchange to Overcome Financial Barriers to Kidney Transplantation,” American Journal of Transplantation, 17, 3, March 2017, 782–790. http://onlinelibrary.wiley.com/doi/10.1111/ajt.14106/full  

a.     M. A. Rees, S. R. Paloyo, A. E. Roth, K. D. Krawiec, O. Ekwenna, C. L. Marsh, A. J. Wenig, T. B. Dunn, “Global Kidney Exchange: Financially Incompatible Pairs Are Not Transplantable Compatible Pairs,” American Journal of Transplantation, 17, 10, October 2017, 2743–2744. http://onlinelibrary.wiley.com/doi/10.1111/ajt.14451/full

b.     A. E. Roth, K. D. Krawiec, S. Paloyo, O. Ekwenna, C. L. Marsh, A. J. Wenig, T. B. Dunn, and M. A. Rees, “People should not be banned from transplantation only because of their country of origin,” American Journal of Transplantation, 17, 10, October 2017, 2747-2748. http://onlinelibrary.wiley.com/doi/10.1111/ajt.14485/full

c.      Ignazio R. Marino, Alvin E. Roth, Michael A. Rees; Cataldo Doria, “Open dialogue between professionals with different opinions builds the best policy, American Journal of Transplantation, 17, 10, October 2017, 2749. http://onlinelibrary.wiley.com/doi/10.1111/ajt.14484/full

10.  Danielle Bozek, Ty B. Dunn, Christian S. Kuhr, Christopher L. Marsh, Jeffrey Rogers, Susan E. Rees, Laura Basagoitia, Robert J. Brunner, Alvin E. Roth, Obi Ekwenna, David E. Fumo, Kimberly D. Krawiec, Jonathan E. Kopke, Puneet Sindhwani, Jorge Ortiz, Miguel Tan, and Siegfredo R. Paloyo, Michael A. Rees, “The Complete Chain of the First Global Kidney Exchange Transplant and 3-yr Follow-up,” European Urology Focus, 4, 2, March 2018, 190-197. https://www.sciencedirect.com/science/article/pii/S2405456918301871

11.  Itai Ashlagi, Adam Bingaman, Maximilien Burq, Vahideh Manshadi, David Gamarnik, Cathi Murphey, Alvin E. Roth,  Marc L. Melcher, Michael A. Rees, ”The effect of match-run frequencies on the number of transplants and waiting times in kidney exchange,” American Journal of Transplantation, 18, 5, May 2018,  1177-1186, https://onlinelibrary.wiley.com/doi/full/10.1111/ajt.14566

12.   Stepkowski, S. M., Mierzejewska, B., Fumo, D., Bekbolsynov, D., Khuder, S., Baum, C. E., Brunner, R. J., Kopke, J. E., Rees, S. E., Smith, C. E., Ashlagi, I., Roth, A. E., Rees, M. A., “The 6-year clinical outcomes for patients registered in a multiregional United States Kidney Paired Donation program- a retrospective study,” Transplant international 32: 839-853. 2019. https://onlinelibrary.wiley.com/doi/10.1111/tri.13423

13.   Roth, Alvin E., Ignazio R. Marino, Obi Ekwenna, Ty B. Dunn, Siegfredo R. Paloyo, Miguel Tan, Ricardo Correa-Rotter, Christian S. Kuhr, Christopher L. Marsh, Jorge Ortiz, Giuliano Testa, Puneet Sindhwani, Dorry L. Segev, Jeffrey Rogers, Jeffrey D. Punch, Rachel C. Forbes, Michael A. Zimmerman, Matthew J. Ellis, Aparna Rege, Laura Basagoitia, Kimberly D. Krawiec, and Michael A. Rees, “Global Kidney Exchange Should Expand Wisely, Transplant International, September 2020, 33, 9,  985-988. https://onlinelibrary.wiley.com/doi/full/10.1111/tri.13656

14.  Vivek B. Kute, Himanshu V. Patel, Pranjal R. Modi, Sayyad J. Rizvi, Pankaj R. Shah, Divyesh P Engineer, Subho Banerjee, Hari Shankar Meshram, Bina P. Butala, Manisha P. Modi, Shruti Gandhi, Ansy H. Patel, Vineet V. Mishra, Alvin E. Roth, Jonathan E. Kopke, Michael A. Rees, “Non-simultaneous kidney exchange cycles in resource-restricted countries without non-directed donation,” Transplant International,  Volume 34, Issue 4, April 2021,  669-680  https://doi.org/10.1111/tri.13833

15.   Afshin Nikzad, Mohammad Akbarpour, Michael A. Rees, and Alvin E. Roth “Global Kidney Chains,” Proceedings of the National Academy of Sciences, September 7, 2021 118 (36) e2106652118; https://doi.org/10.1073/pnas.2106652118 .

16.    Alvin E. Roth, Ignazio R. Marino, Kimberly D. Krawiec, and Michael A. Rees, “Criminal, Legal, and Ethical Kidney Donation and Transplantation: A Conceptual Framework to Enable Innovation,” Transplant International  (2022), 35: doi: 10.3389/ti.2022.10551, https://www.frontierspartnerships.org/articles/10.3389/ti.2022.10551/full

17.   Ignazio R. Marino, Alvin E. Roth, and Michael A. Rees, “Living Kidney Donor Transplantation and Global Kidney Exchange,” Experimental and Clinical Transplantation (2022), Suppl. 4, 5-9. http://www.ectrx.org/class/pdfPreview.php?year=2022&volume=20&issue=8&supplement=4&spage_number=5&makale_no=0

18.  Agarwal, Nikhil, Itai Ashlagi, Michael A. Rees, Paulo Somaini, and Daniel Waldinger. "Equilibrium allocations under alternative waitlist designs: Evidence from deceased donor kidneys." Econometrica 89, no. 1 (2021): 37-76.

And here’s a report of work in progress:

The First 52 Global Kidney Exchange Transplants: overcoming multiple barriers to transplantation by MA Rees, AE Roth , IR Marino, K Krawiec, A Agnihotri, S Rees, K Sweeney, S Paloyo, T Dunn, M Zimmerman, J Punch, R Sung, J Leventhal, A Alobaidli, F Aziz, E Mor, T Ashkenazi, I Ashlagi, M Ellis, A Rege, V Whittaker, R Forbes, C Marsh, C Kuhr, J Rogers, M Tan, L Basagoitia, R Correa-Rotter, S Anwar, F Citterio, J Romagnoli, and O Ekwenna.  Transplantation: September 2022 - Volume 106 - Issue 9S - p S469 doi: 10.1097/01.tp.0000887972.53388.77  https://journals.lww.com/transplantjournal/Fulltext/2022/09001/423_9__The_First_52_Global_Kidney_Exchange.697.aspx

Yale SOM celebrates Vahideh Manshadi on the benefits of scale in kidney exchange

In Yale Insights (from Yale SOM):

Kidney Exchange Registries Should Collaborate to Save More Lives
VAHIDEH MANSHADI

"The results were surprising, says Manshadi. “We didn’t find any evidence that higher-frequency match runs were reducing the overall number of transplants by depleting the pool of potential donors. The total number of transplants remained stable.”

"What the researchers did find, however, was an unexpectedly high number of patients in both programs whose antibodies made them hard to match—what are called sensitized patients.

“The majority of patients in these programs are sensitized,” Manshadi says. “These patients have such high levels of antibodies in their blood that they are more likely to reject a donor organ. Frequent or infrequent matching will have little effect on them because it’s so much harder to find a donor whose kidney they can accept.”

"The best way of improving the outlook for these patients, says Manshadi, is to ensure they are prioritized when searching for matches. That, and find new ways of increasing—and diversifying—the number and range of donors coming into exchange programs. "
*********

And here's the original paper:

Effect of match‐run frequencies on the number of transplants and waiting times in kidney exchange
Itai Ashlagi  Adam Bingaman  Maximilien Burq  Vahideh Manshadi  David Gamarnik  Cathi Murphey  Alvin E. Roth  Marc L. Melcher  Michael A. Rees, American Journal of Transplantation, Volume18, Issue5, May 2018, Pages 1177-1186
First published: 31 October 2017 https://doi.org/10.1111/ajt.14566

Abstract
Numerous kidney exchange (kidney paired donation [KPD]) registries in the United States have gradually shifted to high‐frequency match‐runs, raising the question of whether this harms the number of transplants. We conducted simulations using clinical data from 2 KPD registries—the Alliance for Paired Donation, which runs multihospital exchanges, and Methodist San Antonio, which runs single‐center exchanges—to study how the frequency of match‐runs impacts the number of transplants and the average waiting times. We simulate the options facing each of the 2 registries by repeated resampling from their historical pools of patient‐donor pairs and nondirected donors, with arrival and departure rates corresponding to the historical data. We find that longer intervals between match‐runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match‐runs for transplanting highly sensitized patients. While we do not find that frequent match‐runs result in fewer transplanted pairs, we do find that increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.

Adam Bingaman and kidney exchange are celebrated (once again) in San Antonio

Kidney exchange is thriving in San Antonio: here are two stories celebrating Adam Binghaman's work at Methodist Specialty and Transplant Hospital:

Adam Bingaman, M.D.; Medical Director of Solid Organ Transplants, HCA Healthcare; Director, Abdominal Transplant Program, Methodist Specialty and Transplant Hospital; Transplant Surgeon, Director Live Donor and Incompatible Kidney Transplant Programs, Methodist Specialty and Transplant Hospital

The gift of life: HCA Healthcare leads nation in live donor kidney transplants
FEBRUARY 22, 2019
“Paired exchange has provided remarkable opportunities for the kidney transplant community,” says Dr. Bingaman. “During the first year in 2008, we did a total of 10 paired donations. Now, fast forward to 2019, we are closing in on our five hundredth paired exchange transplant at Methodist Specialty and Transplant Hospital.”
********
and
The Match Game: DR. ADAM BINGAMAN has created a groundbreaking
program that, for the 30 million people suffering from kidney disease, is very good news  
by timothy dumas, photography by hulya
***********

Here are all my posts referring to Dr. Bingaman:  https://marketdesigner.blogspot.com/search?q=bingaman&max-results=20&by-date=true

Kidney Exchange at Methodist of San Antonio

Good matching algorithms and software, innovative histocompatibility tests, recruiting lots of compatible pairs and good surgery and administration combine to make an exemplary single center kidney exchange program:

400 Kidney Paired Donor Transplants at a Single Center; The Methodist San Antonio Experience
A. Bingaman, M. Kapturczak, I. Ashlagi, C. Murphey.

Background: Kidney paired donation (KPD) has become the standard of care for incompatible living donor pairs. Several mature national KPD programs exist yet KPD transplants only represent about 11% of total live donor transplants in the U.S., less than predicted by computer modeling. Methods: We initiated a single center KPD program in 2008. Consenting pairs were entered into our KPD database with blood types, HLA types and unacceptable antigens individually assigned based upon single antigen bead analysis. Results: Between March 2008 and October 2017 our single center KPD program has done 400 KPD transplants, representing 26% of total living donor transplants at our center. These transplants include 57 2-way exchanges, 36 3-way exchanges, 9 4-way exchanges, 6 5-way exchanges, 2 6-way exchanges and 13 non-directed donor (NDD) initiated chains ranging in length from 3-23 recipients. 218 patients were sensitized HLA incompatible with their original donors including 111 (51%) with cPRA >80% and 53 (24%) with cPRA >99%. 62 recipients (15.5%) were re-transplant patients. A total of 43 patients underwent desensitization for positive flow crossmatch or ABO incompatibility. A total of 222 (55%) blood type O donors were utilized of which 212 (95.5%) were transplanted into blood type O recipients or non-O recipients with cPRA >80%. 22 blood type A2 donors were utilized, of which 15 (68%) were transplanted into non-A recipients. 51 compatible pair donors were utilized of which 48 donors (94%) were blood type O or A2, and 3 donors (6%) were blood type A1. Compatible pairs participated in a total of 155 KPD transplants. All compatible pair recipients received kidneys from younger donors. Overall one year graft survival is 98.7%. Conclusions: We report the largest single center KPD program in the world. With limited NDDs, KPD programs must utilize blood type A2 donors and compatible pairs in order to transplant blood type O recipients effectively. To transplant the most highly sensitized patients, combination of KPD and desensitization is very effective with excellent outcomes.

CITATION INFORMATION: Bingaman A., Kapturczak M., Ashlagi I., Murphey C. 400 Kidney Paired Donor Transplants at a Single Center; The Methodist San Antonio Experience Am J Transplant. 2017;17 (suppl 3).

**************

Earlier:

Utilization of Compatible Pairs in a Large Kidney Paired Donation Program

A. Bingaman, F. Wright, M. Kapturczak, L. Shen, C. Murphey

Methodist Specialty and Transplant Hospital, San Antonio, TX
Southwest Immunodiagnostics, San Antonio, TX

Meeting: 2013 American Transplant Congress

Background: Our center has established a very large single center kidney paired donation (KPD) program. A significant barrier to KPD transplant has been the unbalanced blood types in the KPD pool which develops over time, including many blood type O recipient candidates and many non-O donor candidates. Additionally, highly sensitized recipient candidates are in competition for rare donor HLA types. Computer modeling has shown that KPD can be significantly expanded by participation of compatible pairs, particularly to enrich the pool of O donors and utilize donors with rare HLA types. Here we report our experience utilizing compatible pairs as a part of our KPD program. Methods: All recipients with consented incompatible donors were entered into our KPD database. In addition, compatible pairs with older donors that were not HLA identical were approached for consent into the database. Compatible recipients were only offered a kidney from a younger exchange donor. Results: Since February 2009, 23 compatible pairs have been utilized in KPD transplants at our single center, including 14 2-way exchanges, 5 3-way exchanges and 4 chain exchanges (chain lengths 10-23 recipients.) Of the compatible pairs, 8 recipients were blood type O and 15 were non-O; 21 donors were blood type O, 1 was type A2 and 1 blood type A1. In marked contrast, of the incompatible pairs which benefited, 20 recipients were blood type O and 3 were non-O; 10 donors were blood type O, 11 were blood type A1 and 2 blood type B. Of the compatible KPD recipients, none were sensitized, whereas of the incompatible recipients 15 were sensitized, 9 with cPRA >80%. All compatible KPD recipients were transplanted with younger kidney donors. The median age of compatible donors was 57 years whereas the median age of incompatible donors was 29 years. Patient and allograft survival are 100% for both compatible and incompatible groups, median follow up 28 months. The compatible KPD option was viewed as favorable by the majority of pairs approached for consent. Conclusions: This is the largest reported experience of compatible pairs utilized in KPD. When employed in a large KPD program, compatible pairs with O donors significantly expand KPD options for both blood type incompatible pairs and highly sensitized recipients. Utilization of compatible pairs should be expanded nationally to increase the opportunity for incompatible pairs to be transplanted through KPD.

Kidney conference: Paris School of Economics, June 28

Kidney Allocation : Evaluation and Perspectives" June 28, 2018 Campus Jourdan - Paris school of economics - Paris

Localisation | Location Campus Jourdan - Paris school of economics - 48 boulevard Jourdan 75014 Paris Floor 1 - Room R1-13

Organisateurs | Organizers Julien Combe (UCL, London), Victor Hiller (LEMMA, U Panthéon-Assas) and, Olivier Tercieux (Paris School of Economics). Program: 09:00 - 10:00 Peter Biro (Hungarian Academy of Sciences) “Kidney Exchange Practices in Europe” 10:00 – 10.30 Coffee Break 10:30 - 11:30 Marie-Alice Macher (Agence de Bio-Médecine) “Kidney transplantation with living donor versus deceased donor in France From the subsidiarity desired by the pioneers to complementarity” 11:30 – 12:30 Victor Hiller (LEMMA, Université Panthéon-Assas) “Perspectives on the Kidney Exchange Program in France” joint with Audry, Combe, He, Jacquelinet, Macher, Tercieux 12:30 – 14:00 Lunch 14:00 - 15:00 Maximilien Burq (MIT) “Effect of Match-run Frequencies on the Number of Transplants and Waiting Times in Kidney Exchange” joint with Ashlagi, Bingaman, Manshadi, Gamarnik, Murphey, Roth, Melcher, Rees 15:00 - 16:00 Daniel Waldinger (MIT) “An Empirical Framework for Sequential Assignment: The Allocation of Deceased Donor Kidneys” joint with Agarwal, Ashlagi, Rees and Somaini 16-00 – 16:30 Coffee Break 16:30 - 17:30 Yinghua He (Rice) “Kidney Exchange in the Shadow of Desensitization” joint with Combe, Hiller and Tercieux

How often should a kidney exchange network run matches? (Often, it turns out...)

Forthcoming in the American Journal of Transplantation:

The effect of match-run frequencies on the number of transplants and waiting times in kidney exchange

Authors

• 
  

  
  

• 
  

• 
  

• 
  

• 
  

• 
  

• 
  

• 
  

• 
  

• Accepted manuscript online: 31 October 2017Full publication history
• DOI: 10.1111/ajt.14566  View/save citation
• Cited by (CrossRef): 0 articlesCheck for updates
• 

• This article has been accepted for publication and undergone full peer review but has not been through the copyediting, typesetting, pagination and proofreading process, which may lead to differences between this version and the Version of Record. Please cite this article as doi: 10.1111/ajt.14566

Abstract

Numerous kidney exchange (kidney paired donor (KPD)) registries in the U.S have gradually shifted to high frequency match-runs, raising the question of whether this harms the number of transplants. We conduct simulations using clinical data from two KPD registries—the Alliance for Paired Donation, which runs multi-hospital exchanges, and Methodist San Antonio, which runs single center exchanges–to study how the frequency of match-runs impacts the number of transplants and the average waiting times. We simulate the options facing each of the two registries by repeated resampling from their historical pools of patient-donor pairs and non-directed donors, with arrival and departure rates corresponding to the historical data. We find that longer intervals between match-runs do not increase the total number of transplants, and that prioritizing highly sensitized patients is more effective than waiting longer between match-runs for transplanting highly sensitized patients. While we do not find that frequent match-runs result in fewer transplanted pairs we do find that increasing arrival rates of new pairs improves both the fraction of transplanted pairs and waiting times.
*************
Update, Dec. 5: the paper is now in it's final form, early online, and you should be able to see the whole thing here.