Deceased donor kidneys allocated out of sequence by organ procurement organizations.
Deceased donor kidneys allocated out of sequence by organ procurement organizations.
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DOI：
10.1111/ajt.16951
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发表时间：
2022-05
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影响因子：
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逝世供者的肾脏分配遵循对潜在受者的排序匹配流程。在特殊情况下，器官获取组织（OPO）可偏离规定的匹配流程。利用2015年至2019年间美国所有逝世供者肾脏移植（Ktx）的匹配数据，我们确定了从933名供者获取的1544个肾脏存在由OPO发起的分配异常情况。大多数OPO（58个中的55个）至少使用过一次该流程，但3个OPO实施了64%的异常分配，且仅有2个移植中心接收了25%的分配异常肾脏移植。在3个异常OPO中的2个，与所有肾脏移植仅35%的增长相比，2015年至2019年间这些移植分别增长了136%和141%。分配异常的供者具有不太有利的特征（中位肾脏供者特征指数[KDPI]为70，41%有高血压病史），但只有29%的KDPI≥85%，且大多数不符合边缘肾脏的传统阈值。分配异常的肾脏流向规模更大、提供接受率更高的中心，以及流向少2个优先点数（相当于少2年等待时间）的受者。由OPO发起的肾脏分配异常情况越来越频繁，且更多地集中在少数异常中心。提高器官利用率的压力不断增加，可能会增加无序分配的风险，从而有可能加剧移植获取方面的差异。
Deceased donor kidney allocation follows a ranked match-run of potential recipients. Organ procurement organizations (OPOs) are permitted to deviate from the mandated match-run in exceptional circumstances. Using match-run data for all deceased donor kidney transplants (Ktx) in the US between 2015–2019, we identified 1,544 kidneys transplanted from 933 donors with an OPO-initiated allocation exception. Most OPOs (55/58) used this process at least once, but 3 OPOs performed 64% of the exceptions and just 2 transplant centers received 25% of allocation exception Ktx. At 2 of 3 outlier OPOs these transplants increased 136% and 141% between 2015–2019 compared to only a 35% increase in all Ktx. Allocation exception donors had less favorable characteristics (median KDPI 70, 41% with history of hypertension), but only 29% had KDPI≥85% and the majority did not meet the traditional threshold for marginal kidneys. Allocation exception kidneys went to larger centers with higher offer acceptance ratios and to recipients with 2 fewer priority points - equivalent to 2 less years of waiting time. OPO-initiated exceptions for kidney allocation are growing increasingly frequent and more concentrated at a few outlier centers. Increasing pressure to improve organ utilization risks increasing out-of-sequence allocations, potentially exacerbating disparities in access to transplantation.
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影响因子：
8.8
作者：
Hart, A.;Lentine, K. L.;Snyder, J. J.
通讯作者：
Snyder, J. J.
影响因子：
19.6
作者：
Mohan, Sumit;Chiles, Mariana C.;Cohen, David J.
通讯作者：
Cohen, David J.
DOI：
10.2215/cjn.02770319
发表时间：
2019-11-07
影响因子：
9.8
作者：
Brennan, Corey;Husain, Syed Ali;Mohan, Sumit
通讯作者：
Mohan, Sumit
影响因子：
2.1
作者：
Cooper, Matthew;Formica, Richard;Pastan, Stephen
通讯作者：
Pastan, Stephen
影响因子：
3.1
作者：
Dube, Geoffrey K.;Brennan, Corey;Mohan, Sumit
通讯作者：
Mohan, Sumit