The Roles of Dominos and Nonsimultaneous Chains in Kidney Paired Donation
The Roles of Dominos and Nonsimultaneous Chains in Kidney Paired Donation
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DOI：
10.1111/j.1600-6143.2009.02622.x
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发表时间：
2009-06-01
影响因子：
8.8
通讯作者：
Segev, D. L.
中科院分区：
文献类型：
--
作者：
Gentry, S. E.;Montgomery, R. A.;Segev, D. L.
扩大肾脏配对捐赠的努力包括将非定向捐赠者（NDD）与不相容的配对配对。在多米诺骨牌配对捐赠（DPD）中，NDD向不相容配对的接受者捐赠，开始一系列同时移植，最后是活体捐赠者向已故捐赠者等待名单上的接受者捐赠。最近，非同时扩展利他供体（NEAD）链被引入。在NEAD链中，由NDD发起的一系列移植的最后一个供体被保留以在稍后的时间捐赠。我们的目标是预测这些策略中的每一个在2年的运作中对配对捐赠计划的影响，这些配对捐赠计划也分配了给定数量的NDD。每个NDD平均促进了1.99例使用DPD的移植，而使用NEAD链的移植为1.90例（p = 0.3），或1.0例直接捐赠给等待名单的移植（p < 0.001）。NEAD链并没有产生更多的移植相比，同时DPD。DPD和NEAD链都放宽了互惠要求，并重新平衡了献血者的血型分布。由于传统的配对捐赠会使许多不相容的配对无法匹配，如果配对捐赠计划要帮助更多的人，必须探索DPD和NEAD链等新方法。
Efforts to expand kidney paired donation have included matching nondirected donors (NDDs) to incompatible pairs. In domino paired donation (DPD), an NDD gives to the recipient of an incompatible pair, beginning a string of simultaneous transplants that ends with a living donor giving to a recipient on the deceased donor waitlist. Recently, nonsimultaneous extended altruistic donor (NEAD) chains were introduced. In a NEAD chain, the last donor of the string of transplants initiated by an NDD is reserved to donate at a later time. Our aim was to project the impact of each of these strategies over 2 years of operation for paired donation programs that also allocate a given number of NDDs. Each NDD facilitated an average of 1.99 transplants using DPD versus 1.90 transplants using NEAD chains (p = 0.3), or 1.0 transplants donating directly to the waitlist (p < 0.001). NEAD chains did not yield more transplants compared with simultaneous DPD. Both DPD and NEAD chains relax reciprocality requirements and rebalance the blood-type distribution of donors. Because traditional paired donation will leave many incompatible pairs unmatched, novel approaches like DPD and NEAD chains must be explored if paired donation programs are to help a greater number of people.