ANZKX communique
April 2021

Update on matching and transplants

The ANZKX was established 1 July 2019 when the Australian (AKX) and New Zealand (NZKE) kidney exchange programs joined, creating the world’s first international program. Since then, the ANZKX has facilitated the transplantation of 91 people. This has included a total of 60 recipients in Australia and 31 in New Zealand in 29 separate chains, 4 of which have involved transporting kidneys between the two countries. Twelve transplants have been completed through the program so far in 2021 and, with changes to matching protocols, we aim to see ongoing increases in the numbers transplanted.

Ongoing disruption due to COVID-19

The COVID-19 pandemic has caused extensive disruption to transplantation over the past 12 months. This was particularly the case for ANZKX as border closures and a dramatic reduction in flights has made reliable transportation of kidneys more difficult. However, we have been able to continue to organise transplants in Australia since September 2020 through the good will of units, who have started surgery early in the morning to allow the kidney to catch a flight, and flexibility with chain planning. This flexibility has included non-simultaneous start times and splitting chains started by non-directed altruistic donors over multiple different days.

Fortunately, the disruption within New Zealand has been less marked. We are currently matching within Australia and New Zealand separately however we plan to recommence matching between the two countries once sufficient flights resume.

Move to continuous matching

Continuous matching began in late 2020 to allow greater flexibility during COVID-19. Continuous matching has provided multiple benefits to the program including:

Greater focus on highly sensitised recipients who are difficult to match.
Potential for faster matching after a donor and recipient pair is entered into the program. This can be of particular benefit for some people such as those seeking a pre-emptive transplant and can reduce the barrier for some to enter the program.
A reduction in the number of transplants that require organisation and scheduling at one time. This reduces the peaks and troughs of work for transplant units and tissue typing laboratories.
Because there are less transplants to book at a time, the time from matching to transplant surgery can be reduced, which can lessen the chance of chains breaking down.
Chains that do break down can be repaired immediately.

Due to these benefits it has been agreed by RACOS that continuous matching will become a permanent protocol change.

How this will change the experience for units and patients

Continuous matching will lead to several changes for transplanting units. The most important is that donor and recipient pairs can be matched as soon as they are entered and made active in the program. Therefore, if a pair is ready to be transplanted then they should be entered as soon as possible.

This also means that we might contact units with an offer of a match at any time. At times we now offer chains in parts to determine whether certain matches are accepted before continuing. Due to this it is important that units review offers and inform us of their decisions as quickly as they can.

In order to make this process practical we will now request that units provide us with an answer regarding whether they wish to accept an offer from a medical and immunological perspective within 48 hours. A decision regarding surgical acceptance is requested within 1 week, to allow review of donor imaging studies.

We are now also hoping to book surgical dates sooner after matches are offered. Where possible we will try to book these within 4-8 weeks from the date of the offer.

Data collection

Long term follow-up of outcomes for people transplanted through ANZKX is collected in ANZDATA. However, in order to ensure we are aware of any issues that occur early after transplant we will now contact units 1 month after surgery to ask about delayed graft function, rejection and kidney function. This is to ensure we are aware of any clinical issues that occur in transplant recipients for quality and safety purposes.

Website upgrade with new protocols and process maps

An update of the ANZKX website has been launched this week. The website can be accessed here -https://donatelife.gov.au/ANZKX

The website has updated information for clinicians including protocols and forms. There is also more information for patients, including patient stories and videos to assist with education.

Previous Hepatitis C infection protocol change

Another change to ANZKX protocol is donors who have had previous hepatitis C infection but are no longer viraemic (hepatitis C antibody positive, RNA negative) will be able to enter the ANZKX program. Recipient units will be informed if their patient is matched with a donor with this profile and the clinicians will be asked to discuss this with the recipient to determine whether they consent to receive a kidney from this donor. A recipient consent form for this is available on our website.

We are always interested to know if there are particular goals that you have when you enter a person into the program. If there are specific goals or priorities, then please let us know at ANZKX@mh.org.au and we are happy to discuss this further with you.

ANZKX communique April 2021