Early Experience Of Electronic Kidney Graft Allocation System In The Republic Of Moldova

Introduction: In the Republic of Moldova, the new stage of solid organ transplantation activities started a decade ago, with the adoption of the new transplantation law in 2008, followed by the creation of Transplant Agency in 2010, and was strongly marked by the first transplant from a brain death donor (DBD) in 2014. The main pillars of the new system were: creation of a strong legal framework, development of transplant infrastructure, development of donation after brain death, implementation of a transparent organ allocation policy. The automated kidney allocation system was created as part of the electronic database: SIA Transplant. The concept of SIA Transplant informational system is to incorporate various functionally interconnected registries (dialysis registry, deceased and living donor registries, transplant registry, transplant waiting list (WL)) and an e-platform for graft allocation. Method: There is a legal requirement for the transplant centers to report all kidney transplants to the SIA Transplant. All the kidney grafts from DBD donors have been allocated based on the Renal Score, which includes the following variables: compatibility in ABO and HLA systems, renal graft accessibility score, time on WL, time on dialysis, age difference between donor and recipient. We analysed allocation results in the last 5 years. Results: During 2014-2018, there were 75 kidney transplantations performed: 52 (69,3 %) from DBD donors and 23 (30,7%) from living donors. Among the kidney transplant recipients, there were 24 women (32,4%) and 50 men (67.6%). During this period, from 110 evaluated potential DBD donors – 48 (43,6%) became effective DBD donors and kidneys were procured in 36 (75%) cases (from 15 men (41,7%) and 21 women (58,3%)). The mean age at donation was 54,72, ranging from 19 to 72 years old. 18 donors (50%) were older than 60, the mean age of male donors were 49,4 and 59,14 for female donors, while the mean recipients age was 41,13, ranging from 23 to 67, with a mean donor-recipient age difference of 17,09 years (min- 0, max- 40). The mean cold ischemia time was 17,31 hours, with a minimum of 6,33 hours and a maximum of 25,8 hours. The majority of donors were blood type 0- 14 (38.8%) and A-13 (36,1%) and only 6 donors (16.6%) blood type B and 3 (8.3%) type AB. Conclusion: Despite social and economic challenges, the kidney transplant program is in development and we persevere to achieve better results. The implementation of SIA Transplant confers traceability and the automated allocation system confers transparency, equity and utility in the process of graft allocation. We still face many challenges, as the quite high rate of marginal donors compared to younger recipients, respectively donor-recipient age disparities, a long cold ischemia time and a sub-optimal organ discard rate. Our next goal is to identify, through the electronic allocation system, the parameters impacting on cadaver kidney graft outcome in order to ensure proper organ allocation.