The national landscape of deceased donor kidney transplantation for the highly sensitized: Transplant rates, waitlist mortality, and posttransplant survival under KAS
The national landscape of deceased donor kidney transplantation for the highly sensitized: Transplant rates, waitlist mortality, and posttransplant survival under KAS
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DOI：
10.1111/ajt.15149
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发表时间：
2019-04-01
影响因子：
8.8
通讯作者：
Garonzik-Wang, Jacqueline
中科院分区：
文献类型：
--
作者：
Jackson, Kyle R.;Covarrubias, Karina;Garonzik-Wang, Jacqueline
在2014年实施肾脏分配系统(KAS)后，高度致敏(HS)候选人的已故供者肾移植(DDKT)率提前上升。然而，这可能是一种推力效应，对于HS候选人DDKT的现状仍缺乏细粒度的调查。我们研究了2011年4月12日至2014年3月12日(“KAS前”)和2014年12月4日至2017年3月12日(“KAS后”)的270 722名残疾儿童考生，使用调整后的负二项回归分析了HS考生的DDKT比率。术后敏感度最高者DDKT率较术前增加(CPRA 98%调整后发病率[aIRR]：(1.27)1.77(2.46)P=.001，CPRA 99%aIRR：(3.18)4.36(5.98)P<；.001，CPRA 99.5-99.9%aIRR：(16.91)24.29(34.89)P<；.001，CPRA 99.9%+aIRR：(8.79)11.58(15.26)P<；.001)。为了确定这些变化是否带来了更公平地获得DDKT，我们比较了HS和非HS候选人的DDKT比率(CPRA 0-79%)。KAS、CPRA后，98%的考生DDKT率与非HS考生相当(aIRR：0.65)0.94(1.36，P=0.8)，而99%的考生DDKT率高于非HS考生(aIRR：1.19)1.68(2.38)，P=0.02。虽然CPRA 99.5-99.9%的考生的DDKT率高于非HS考生(aIRR：(2.46)3.50(4.98)，P<；.001)，但CPRA 99.9%以上的考生的DDKT率显著低于非HS考生(aIRR：(0.29)0.40(0.56)，P<；.001)。KAS改善了HS考生获得DDKT的机会，尽管CPRA 99.5-99.9%和99.9%以上的考生之间存在很大的不平衡。
Deceased donor kidney transplantation (DDKT) rates for highly sensitized (HS) candidates increased early after implementation of the Kidney Allocation System (KAS) in 2014. However, this may represent a bolus effect, and a granular investigation of the current state of DDKT for HS candidates remains lacking. We studied 270 722 DDKT candidates from the SRTR from 12/4/2011 to 12/3/2014 ("pre-KAS") and 12/4/2014 to 12/3/2017 ("post-KAS"), analyzing DDKT rates for HS candidates using adjusted negative binomial regression. Post-KAS, candidates with the highest levels of sensitization had an increased DDKT rate compared with pre-KAS (cPRA 98% adjusted incidence rate ratio [aIRR]:(1.27)1.77(2.46) P = .001, cPRA 99% aIRR:(3.18)4.36(5.98) P < .001, cPRA 99.5-99.9% aIRR:(16.91)24.29(34.89) P < .001, and cPRA 99.9%+ aIRR:(8.79)11.58(15.26) P < .001). To determine whether these changes produced more equitable access to DDKT, we compared DDKT rates of HS to non-HS candidates (cPRA 0-79%). Post-KAS, cPRA, 98% candidates had an equivalent DDKT rate (aIRR:(0.65)0.94(1.36), P = .8) to non-HS candidates, whereas 99% candidates had a higher DDKT rate (aIRR:(1.19)1.68(2.38), P = .02). Although cPRA 99.5-99.9% candidates had an increased DDKT rate (aIRR:(2.46)3.50(4.98), P < .001) compared to non-HS candidates, cPRA 99.9%+ candidates had a significantly lower DDKT rate (aIRR:(0.29)0.40(0.56), P < .001). KAS has improved access to DDKT for HS candidates, although substantial imbalance exists between cPRA 99.5-99.9% and 99.9%+ candidates.