Kidney exchange is an innovative option for patients who need a kidney but cannot receive it from their donors due to biological incompatibility. Incompatible patient-donor pairs can be matched to other incompatible pairs allowing for a cross- transplant. The simplest kidney swap involves two pairs but exchange in cycles (when more pairs involved) or in chains (when altruistic donor without “pair” initiates exchange) are also possible. In 2012, Prof. Alvin Roth received a Nobel Prize in Economic Sciences for his contribution to developing matching algorithms used in kidney exchange. Shortly afterwards, kidney exchange has revolutionized the way kidney transplants are performed in the USA.
Inspired by the work of prof. Roth, Piotr Dworczak and I asked the question: how would the number of kidney transplants increase if kidney exchanges were introduced for Polish patients who are immunologically different than Americans? Our results are extremely encouraging and show that the number of living-donor transplants could increase almost twofold. Therefore, when the first paired kidney donation was performed in Poland at the Infant Jesus Clinical Hospital in Warsaw, we began collaborating with the Department of General Surgery and Transplantology to develop a matching algorithm and software to optimize kid-ney exchange. The algorithm maximizes the number of transplants subject to maintaining their high quality.
Manually it is almost impossible to choose optimal cycle of cross-transplants from database of patients. The number of combinatorial possibilities to match donors and recipients on the basis of their immunological and clinical data is huge. Finding a solution to design optimal exchange is a very difficult mathematical problem, one of so-called NP-hard problems. To solve this kind of problem in clinical practice, software using matching algorithms is need-ed. By the use of software it is possible to design transplant exchanges fast and ensure the best possible match of immunological parameters.
Developing matching software is an important step forward into Polish kidney exchange program and an endeavor to save people’s lives. However the problem remains that there are not enough live donors in Poland. Only 6 % of transplanted kidneys derives from live do-nors, while in the European Union the number is around 20% and in the world reaches even up to 40%. This is the argument for increasing this percentage in Poland with kidney ex-change. Preliminary results from our mathematical simulations indicate that the gains from using pairwise kidney exchange in Poland are huge – it can lead to more than doubling of the number of conducted transplants. Additionally there is a promising observation derived from our simulation, that if the probability of having a donor increases, number of conduct-ed transplant is going to constitutively increase with kidney exchange.
By our work we would like to show that a minor project of young Polish scientists, studying in Poland and abroad, can develop into a greater enterprise combining medicine, econom- ics, and IT. Thanks to Polish transplantologists (Prof. Artur Kwiatkowski, Prof. Andrzej Chmura and dr Rafal Kieszek, who performed the first kidney exchange in Poland), our small pro-ject has been developed further into software which they really need. Now, equipped with matching software, the transplant clinic could become innovative center for kidney cross- transplant.
The clinic is already at a forefront because it invests in people. The passionate team of medical doctors and investigators I work with, has an entrepreneurial spirit and grand ideas for the future with the aim to develop cooperation between the transplant clinic, academia and businesses to save people’ lives and fuel medical science.
About the Author
Anna Kornakiewicz: I am a young M.D. with background in drug discovery. I am doing my PhD in systems medicine and apply computational approach to solve medical and biological problems. Two big areas of interests which ensure context for my research questions are kidney cancer and kidney transplantation. I am engaged in developing matching software for kidney exchange. I support gifted education and I am also active participant and organizer of networking initiatives for passionate young scientist and entrepreneurs in Poland and abroad.