Improving Distribution Efficiency of Hard-to-Place Deceased Donor Kidneys: Predicting Probability of Discard or Delay
Improving Distribution Efficiency of Hard-to-Place Deceased Donor Kidneys: Predicting Probability of Discard or Delay
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DOI：
10.1111/j.1600-6143.2010.03163.x
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发表时间：
2010-07-01
影响因子：
8.8
通讯作者：
Segev, D. L.
中科院分区：
文献类型：
--
作者：
Massie, A. B.;Desai, N. M.;Segev, D. L.
我们最近发现，DonorNet 2007降低了美国肾脏分配的效率，特别是对于那些冷缺血时间（CIT）延长的患者，因为无论质量如何，都需要系统分配所有肾脏。可靠的早期识别那些最有可能被丢弃或严重延误的，将使他们能够分配到替代，更有效的分配战略。基于2005年至2008年期间为可能的移植而回收的39 035个成人肾脏，我们创建了一个回归模型，该模型可靠地（AUC 0.83）量化了给定肾脏被丢弃或延迟超过36小时CIT的概率（丢弃/延迟概率，PODD）。然后，我们分析了两个PODD截止值：一个允许的截止值，成功标记了超过一半的被丢弃/延迟的肾脏，而只有7%的肾脏最终没有被丢弃/延迟，和一个更严格的截止值，错误地标记只有3%，但也正确识别只有34%。高PODD的肾移植集中在少数中心。修改肾脏分配系统，以更有效地将具有高PODD的器官引导到实际使用它们的中心，可能会导致CIT降低和丢弃减少。
We recently showed that DonorNet 2007 has reduced the efficiency of kidney distribution in the United States, particularly for those with prolonged cold ischemia time (CIT), by requiring systematic allocation of all kidneys regardless of quality. Reliable early identification of those most likely to be discarded or significantly delayed would enable assigning them to alternate, more efficient distribution strategies. Based on 39 035 adult kidneys recovered for possible transplantation between 2005 and 2008, we created a regression model that reliably (AUC 0.83) quantified the probability that a given kidney was either discarded or delayed beyond 36 h of CIT (Probability of Discard/Delay, PODD). We then analyzed two PODD cutoffs: a permissive cutoff that successfully flagged over half of those kidneys that were discarded/delayed, while only flagging 7% of kidneys that were not eventually discarded/delayed, and a more stringent cutoff that erroneously flagged only 3% but also correctly identified only 34%. Kidney transplants with high PODD were clustered in a minority of centers. Modifications of the kidney distribution system to more efficiently direct organs with high PODD to the centers that actually use them may result in reduced CIT and fewer discards.