Geographic disparity in kidney transplantation under KAS.
Geographic disparity in kidney transplantation under KAS.
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DOI：
10.1111/ajt.14622
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发表时间：
2018-06
期刊：
影响因子：
--
通讯作者：
Gentry SE
中科院分区：
文献类型：
--
作者：
Zhou S;Massie AB;Luo X;Ruck JM;Chow EKH;Bowring MG;Bae S;Segev DL;Gentry SE
肾脏分配系统从根本上改变了肾脏分配，导致区域和国家共享的大幅增加，我们假设这可能会影响地理差异。我们测量了KAS（6/1/2015-12/1/2016）下死亡供体肾移植（DDKT）率的地理差异，并与KAS前（6/1/2013-12/3/2014）进行了比较。我们采用多级Poisson回归模型对DSA水平的DDKT率进行建模，并根据KAS下的分配因素进行调整。使用该模型，我们计算了一种新的、改进的地理差异度量：移植率的中位发病率比（MIRR），这是一种衡量DSA水平变异的指标，它考虑了患者病例数，对离群值具有鲁棒性。在KAS下，成年人的MIRR为1.751.811.86，这意味着不同DSA的相似候选人的DDKT率中位数差异为1.81倍。地理因素的影响大于KAS强调的因素的影响：EPTS评分≤20%与移植率增加1.40倍相关（IRR=1.351.401.45，p<0.01），3年透析年份与移植率增加1.57倍相关（IRR=1.561.571.59，p<0.001）。对于儿科候选人，MIRR更为明显，为1.661.922.27。KAS的地理差异没有变化（p=0.3）。尽管KAS下肾脏分配发生了广泛变化，但地理位置仍然是获得DDKT的主要决定因素。
The Kidney Allocation System fundamentally altered kidney allocation, causing a substantial increase in regional and national sharing that we hypothesized might impact geographic disparities. We measured geographic disparity in deceased donor kidney transplant (DDKT) rate under KAS (6/1/2015–12/1/2016), and compared that with pre-KAS (6/1/2013–12/3/2014). We modeled DSA-level DDKT rates with multilevel Poisson regression, adjusting for allocation factors under KAS. Using the model we calculated a novel, improved metric of geographic disparity: the median incidence rate ratio (MIRR) of transplant rate, a measure of DSA-level variation that accounts for patient casemix and is robust to outlier values. Under KAS, MIRR was 1.751.811.86 for adults, meaning that similar candidates across different DSAs have a median 1.81-fold difference in DDKT rate. The impact of geography was greater than the impact of factors emphasized by KAS: having an EPTS score ≤20% was associated with a 1.40-fold increase (IRR=1.351.401.45, p<0.01) and a 3-year dialysis vintage was associated with a 1.57-fold increase (IRR=1.561.571.59, p<0.001) in transplant rate. For pediatric candidates, MIRR was even more pronounced, at 1.661.922.27. There was no change in geographic disparities with KAS (p=0.3). Despite extensive changes to kidney allocation under KAS, geography remains a primary determinant of access to DDKT.
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影响因子：
8.8
作者：
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通讯作者：
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DOI：
10.2215/cjn.05350513
发表时间：
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影响因子：
9.8
作者：
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通讯作者：
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影响因子：
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作者：
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