COMPUTER ANALYSIS OF CADAVER KIDNEY ALLOCATION PROCEDURES
COMPUTER ANALYSIS OF CADAVER KIDNEY ALLOCATION PROCEDURES
复制标题
尸体肾脏分配程序的计算机分析
作者：
T. Wujciak;G. Opelz
利用32,000名捐赠者的数据进行计算机模拟，以分析选择参数对肾移植结果的影响。如果在器官分配中考虑人类白细胞抗原配型等级，二次移植的整体1年存活率比不考虑人类白细胞抗原配型的情况高出7%。然而，这种单一的以成功为导向的器官分配方法，导致罕见的人类白细胞抗原表型患者的等待时间延长。我们开发了一种产生接近理论最佳结果的选择程序：95%的患者可以在0-2个HLA-A、-B、-DR抗原不匹配的情况下进行移植，平均等待时间减少到20个月，并且没有患者需要等待超过6年的移植。总体移植物存活率仅比严格面向人类白细胞抗原的分配率低0.4%。该方法可以防止“配型不佳”的患者在等待名单上堆积。此外，北美接受者池中不利的种族比例可以在很大程度上正常化。
Data of 32,000 donors were utilized for a computer simulation to analyze the effect of selection parameters on the outcome of kidney transplants. If the HLA match grade is considered for organ allocation, the overall 1‐year graft survival rate is up to 7% higher for second transplants than if HLA matching is disregarded. This solely success‐oriented organ allocation method, however, leads to prolonged waiting times for patients with rare HLA phenotypes. We developed a selection procedure that yields results near the theoretical optimum: 95% of all patients can be transplanted with 0‐2 HLA‐A,‐B,‐DR antigen mismatches, the average waiting time decreases to 20 months, and no patient needs to wait longer for a transplant than 6 years. The overall graft survival rate is only 0.4% lower than the rate obtainable with strictly HLA‐oriented allocation. The method prevents “poorly matchable" patients from accumulating on the waiting list. Additionally, the unfavorable race ratio in the North American recipient pool can be largely normalized.