{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,2]],"date-time":"2026-06-02T09:29:24Z","timestamp":1780392564800,"version":"3.54.1"},"reference-count":56,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,1]]},"abstract":"<jats:sec>\n            <jats:title>Background.<\/jats:title>\n            <jats:p>Most transplantation centers recognize a small patient population that unsuccessfully participates in all available, both living and deceased donor, transplantation programs for many years: the difficult-to-match patients. This population consists of highly immunized and\/or ABO blood group O or B patients.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Methods.<\/jats:title>\n            <jats:p>To improve their chances, Computerized Integration of Alternative Transplantation programs (CIAT) were developed to integrate kidney paired donation, altruistic\/unspecified donation, and ABO and HLA desensitization. To compare CIAT with reality, a simulation was performed, including all patients, donors, and pairs who participated in our programs in 2015\u20132016. Criteria for inclusion as difficult-to-match, selected-highly immunized (sHI) patient were as follows: virtual panel reactive antibody &gt;85% and participating for 2 years in Eurotransplant Acceptable Mismatch program. sHI patients were given priority, and ABO blood group incompatible (ABOi) and\/or HLA incompatible (HLAi) matching with donor-specific antigen\u2013mean fluorescence intensity (MFI) &lt;8000 were allowed. For long-waiting blood group O or B patients, ABOi matches were allowed.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Results.<\/jats:title>\n            <jats:p>In reality, 90 alternative program transplantations were carried out: 73 compatible, 16 ABOi, and 1 both ABOi and HLAi combination. Simulation with CIAT resulted in 95 hypothetical transplantations: 83 compatible (including 1 sHI) and 5 ABOi combinations. Eight sHI patients were matched: 1 compatible, 6 HLAi with donor-specific antigen-MFI &lt;8000 (1 also ABOi), and 1 ABOi match. Six\/eight combinations for sHI patients were complement-dependent cytotoxicity cross-match negative.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions.<\/jats:title>\n            <jats:p>CIAT led to 8 times more matches for difficult-to-match sHI patients. This offers them better chances because of a more favorable MFI profile against the new donor. Besides, more ABO compatible matches were found for ABOi couples, while total number of transplantations was not hampered. Prioritizing difficult-to-match patients improves their chances without affecting the chances of regular patients.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1097\/tp.0000000000003203","type":"journal-article","created":{"date-parts":[[2020,2,25]],"date-time":"2020-02-25T21:21:27Z","timestamp":1582665687000},"page":"240-248","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":13,"title":["Creating Options for Difficult-to-match Kidney Transplant Candidates"],"prefix":"10.1097","volume":"105","author":[{"given":"Marry","family":"de Klerk","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Judith A.","family":"Kal-van Gestel","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jacqueline","family":"van de Wetering","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marcia L.","family":"Kho","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sandra","family":"Middel-de Sterke","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michiel G.H.","family":"Betjes","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Willij C.","family":"Zuidema","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dave","family":"Roelen","sequence":"additional","affiliation":[{"name":"Department of Immunohaematology and Blood Transfusion LUMC, Leiden, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristiaan","family":"Glorie","sequence":"additional","affiliation":[{"name":"Erasmus Q-Intelligence, Erasmus University Rotterdam, Rotterdam, The Netherlands."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joke I.","family":"Roodnat","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The 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