Trends in Disparities in Preemptive Kidney Transplantation in the United States
Trends in Disparities in Preemptive Kidney Transplantation in the United States
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DOI：
10.2215/cjn.03140319
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发表时间：
2019-10-07
影响因子：
9.8
通讯作者：
Mohan, Sumit
中科院分区：
文献类型：
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作者：
King, Kristen L.;Husain, Syed Ali;Mohan, Sumit
背景和目的在美国，死亡供肾等待时间长和优先等待率低限制了优先移植。我们的目的是评估2014年引入新的肾脏分配系统（KAS）后的抢先死亡供体移植的趋势，并确定抢先移植的关键差异是否发生了变化。设计、设置、参与者和测量我们使用移植受体科学登记系统确定了2000年至2018年美国成年死亡供体肾移植受体。预先移植定义为移植前未进行透析。使用逻辑回归计算受体、供体、移植和政策时代特征与抢先移植之间的关联。结果实施KAS后，抢先移植的比例从9.0%上升到9.8%，其中1.10与KAS前相比，KAS后抢先移植的几率高（95%置信区间[95%CI]，1.06至1.14）倍。优先接受者更可能是白色、老年人、女性、受教育程度更高、持有私人保险、患有糖尿病或高血压以外的ESKD。政策时代显著改变了优先移植与种族、年龄、保险状况和人类白细胞抗原零错配之间的关系（交互作用P
Background and objectives Long wait times for deceased donor kidneys and low rates of preemptive wait-listing have limited preemptive transplantation in the United States. We aimed to assess trends in preemptive deceased donor transplantation with the introduction of the new Kidney Allocation System (KAS) in 2014 and identify whether key disparities in preemptive transplantation have changed.Design, setting, participants, & measurements We identified adult deceased donor kidney transplant recipients in the United States from 2000 to 2018 using the Scientific Registry of Transplant Recipients. Preemptive transplantation was defined as no dialysis before transplant. Associations between recipient, donor, transplant, and policy era characteristics and preemptive transplantation were calculated using logistic regression. To test for modification by KAS policy era, an interaction term between policy era and each characteristic of interest was introduced in bivariate and adjusted models.Results The proportion of preemptive transplants increased after implementation of KAS from 9.0% to 9.8%, with 1.10 (95% confidence interval [95% CI], 1.06 to 1.14) times higher odds of preemptive transplantation post-KAS compared with pre-KAS. Preemptive recipients were more likely to be white, older, female, more educated, hold private insurance, and have ESKD cause other than diabetes or hypertension. Policy era significantly modified the association between preemptive transplantation and race, age, insurance status, and Human Leukocyte Antigen zero-mismatch (interaction P