Maximizing Effectiveness and Equity in Kidney Exchange Programs for Novel Compatibility Paradigms
Valentina Peralta Clarke, Hans de Ferrante, Francisco Perez Galarce, Joris van de Klundert
TL;DR
This study addresses how three HLA compatibility paradigms—antigen (low-resolution), allele (high-resolution), and eplet (epitope-based)—affect kidney exchange program (KEP) effectiveness and ethnic equity. It融合es a simulation-optimization framework with an equity weighting mechanism to compare paradigms, guided by case-study data derived from OPTN, Haplostats imputations, and DSA mappings. Key findings show that moving to allele or eplet paradigms can improve predictive accuracy but may widen ethnic inequities in transplant access and waiting times; introducing Rawlsian-like equity weights can eliminate disparities in transplant probability without reducing overall transplant probability, albeit with trade-offs in HLA compatibility for some subpopulations. The work provides policy-relevant insights for adopting higher-resolution HLA matching in KEPs and highlights the need for careful equity-aware design when deploying such paradigms in practice, while acknowledging data limitations and the need to integrate LYFT/QALYs more fully as data mature.
Abstract
Kidney Exchange Programs (KEPs) promote access to living donor trans- plantation for patients suffering from end stage renal disease. The HLA compatibility between transplant recipients and donors plays an important role when solving the matching problems occuring in KEPs. Compatibility defines the feasible solution space and often occurs in a weighted form in the objective function. Recently, the paradigms used to express HLA com- patibility have advanced substantially from antigens to alleles and eplets. We show how KEP effectiveness and equity vary with these three paradigms. The equity analysis focuses on ethnic inequities and the result confirm that moving from antigen to allele and eplet paradigms may enlarge inequities. We present new optimization models based on equity weighting that rem- edy ethnic inequities for all three paradigms without sacrificing access to transplant.