Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation
Changes in Deceased Donor Kidney Transplantation One Year After KAS Implementation
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DOI：
10.1111/ajt.13770
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发表时间：
2016-06-01
影响因子：
8.8
通讯作者：
Aeder, M. I.
中科院分区：
文献类型：
--
作者：
Stewart, D. E.;Kucheryavaya, A. Y.;Aeder, M. I.
经过十多年的讨论、分析和建立共识，新的肾脏分配系统（KAS）于2014年12月4日实施。关键目标包括改善供肾和受体之间的寿命匹配，扩大历史上处于不利地位的亚群，特别是高度致敏的患者和透析时间延长但转诊延迟的患者。为了评估KAS的早期影响，我们比较了实施前1年与实施后1年的器官获取和移植网络数据。移植在许多受者特征上的分布发生了显著变化，这表明新政策在许多方面正在实现其目标。供体和受体年龄相差超过30岁的移植减少了23%。对于计算的小组反应性抗体99-100%接受者和至少接受10年透析的接受者，观察到移植的初始急剧增加，随后这些组的移植逐渐减少，表明推注效应。虽然KAS可以说增加了分配的公平性，但必须考虑扩大准入的潜在成本。肾脏更经常被长途运输，导致冷缺血时间增加。移植物功能延迟恢复率增加，但6个月移植物存活率没有显著变化。
After over a decade of discussion, analysis, and consensus-building, a new kidney allocation system (KAS) was implemented on December 4, 2014. Key goals included improving longevity matching between donor kidneys and recipients and broadening access for historically disadvantaged subpopulations, in particular highly sensitized patients and those with an extended duration on dialysis but delayed referral for transplantation. To evaluate the early impact of KAS, we compared Organ Procurement and Transplantation Network data 1 year before versus after implementation. The distribution of transplants across many recipient characteristics has changed markedly and suggests that in many ways the new policy is achieving its goals. Transplants in which the donor and recipient age differed by more than 30 years declined by 23%. Initial, sharp increases in transplants were observed for Calculated Panel-Reactive Antibody 99-100% recipients and recipients with at least 10 years on dialysis, with a subsequent tapering of transplants to these groups suggesting bolus effects. Although KAS has arguably increased fairness in allocation, the potential costs of broadening access must be considered. Kidneys are more often being shipped over long distances, leading to increased cold ischemic times. Delayed graft function rates have increased, but 6-month graft survival rates have not changed significantly.