Impact of Extending Eligibility for Reinstatement of Waiting Time After Early Allograft Failure: A Decision Analysis.
Impact of Extending Eligibility for Reinstatement of Waiting Time After Early Allograft Failure: A Decision Analysis.
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DOI：
10.1053/j.ajkd.2021.07.023
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发表时间：
2022-03
期刊：
影响因子：
--
通讯作者：
Perotte R
中科院分区：
文献类型：
--
作者：
Husain SA;King KL;Adler JT;Mohan S;Perotte R
在美国，被确定为可能进行移植的已故捐赠者肾脏的短缺，由于在采购后丢弃的已故捐赠者肾脏的比例很高，这一问题更加严重。我们评估了一项旨在通过延长移植后同种异体移植失败受者等待时间恢复资格来提高器官利用率的政策建议的影响。根据临床登记数据进行决策分析。我们使用器官采购和移植网络的数据识别了2013至2017年间在美国购买的76,044个已故捐赠者肾脏(DDK)，其中80%被移植，20%被丢弃。将同种异体移植失败受者的等待时间从目前的90天延长到一年。对等待名单的净影响，定义为估计的额外移植数量减去恢复等待名单的估计增加。我们估计了(1)如果相对减少5%-25%的丢弃，将额外移植的已故供者肾脏的数量，以及(2)根据6、12、18和24个月的恢复政策将重新获得等待时间的受者的数量。对于移植后出现同种异体移植失败的受者恢复等待时间长达一年，在所有模型假设下，除了相对丢弃率非常低(5%)和移植肾脏失败率非常高(≥是当前移植肾脏的5倍)之外，额外的移植产生了比等待名单上的增长更多的移植。缺乏经验证据支持这种政策变化的拟议影响。对于移植后1年内发生移植失败的已故供肾受者恢复等待时间的政策改变，应该探索作为一种以科学为基础的决策干预措施，以提高器官利用率。
The shortage of deceased donor kidneys identified for potential transplantation in the United States is exacerbated by a high proportion of deceased donor kidneys discarded after procurement. We estimated the impact of a policy proposal aiming to increase organ utilization by extending eligibility for waiting time reinstatement for recipients experiencing allograft failure following transplantation. Decision analysis informed by clinical registry data. We used Organ Procurement and Transplantation Network data to identify 76,044 deceased-donor kidneys (DDKs) procured in the United States from 2013 to 2017, 80% of which were transplanted and 20% discarded. Extend waiting time reinstatement for recipients experiencing allograft failure from the current 90 days to 1 year following transplantation. Net impact to the waitlist, defined as the estimated number of additional transplants minus estimated increase in waiting list reinstatements. We estimated (1) the number of additional deceased donor kidneys that would be transplanted if there was a 5%-25% relative reduction in discards, and (2) the number of recipients who would regain waiting time under a 6-, 12-, 18-, and 24-month reinstatement policy. Reinstating waiting time for recipients experiencing allograft failure up to 1-year following transplantation yielded more additional transplants than growth in additions to the waiting list for all model assumptions except the combination of a very low relative reduction in discards (5%) and a very high failure rate of transplanted kidneys that would previously have been discarded (≥5 times the rate of currently transplanted kidneys). Lack of empirical evidence supporting the proposed impact of such a policy change. A policy change reinstating waiting time for deceased donor kidneys recipients with allograft failure up to 1 year following transplantation should explored as a decision science-based intervention to improve organ utilization.
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