Nonsimultaneous Chains and Dominos in Kidney- Paired Donation-Revisited
Nonsimultaneous Chains and Dominos in Kidney- Paired Donation-Revisited
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DOI：
10.1111/j.1600-6143.2011.03481.x
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发表时间：
2011-05-01
影响因子：
8.8
通讯作者：
Rees, M. A.
中科院分区：
文献类型：
--
作者：
Ashlagi, I.;Gilchrist, D. S.;Rees, M. A.
自 2008 年以来，美国肾脏交换的增长部分源于移植链中非定向捐赠者的加入，而不是简单的交换。这些链是否应该同时进行“多米诺配对捐赠”（DPD）还是非同时进行“非同时扩展利他捐赠链”（NEAD）存在争议。 NEAD 链创建“桥梁捐赠者”，其不相容的受者在桥梁捐赠者捐赠之前接受肾脏，因此存在桥梁捐赠者食言的风险，但通过克服同时链中固有的后勤障碍，提供了创造更多移植的机会。金特里等人。模拟了当链段长度限制为三个移植物时，DPD 或 NEAD 链是否会产生更多的移植物，并报道 DPD 的性能至少与 NEAD 链一样好。由于这一发现与参与肾脏配对捐赠的几个团体的经验形成鲜明对比，我们进行了允许更长链段的模拟，并使用了来自配对捐赠联盟的实际患者数据。当模拟中允许 4-6 个移植的链段时，NEAD 链比 DPD 产生更多的移植。我们的模拟不仅显示随着链长度的增加，移植数量也会增加，而且 NEAD 链为高度敏感和 O 型血受体产生了更多的移植。
Since 2008, kidney exchange in America has grown in part from the incorporation of nondirected donors in transplant chains rather than simple exchanges. It is controversial whether these chains should be performed simultaneously 'domino-paired donation', (DPD) or nonsimultaneously 'nonsimultaneous extended altruistic donor, chains (NEAD). NEAD chains create 'bridge donors' whose incompatible recipients receive kidneys before the bridge donor donates, and so risk reneging by bridge donors, but offer the opportunity to create more transplants by overcoming logistical barriers inherent in simultaneous chains. Gentry et al. simulated whether DPD or NEAD chains would produce more transplants when chain segment length was limited to three transplants, and reported that DPD performed at least as well as NEAD chains. As this finding contrasts with the experience of several groups involved in kidney-paired donation, we performed simulations that allowed for longer chain segments and used actual patient data from the Alliance for Paired Donation. When chain segments of 4-6 transplants are allowed in the simulations, NEAD chains produce more transplants than DPD. Our simulations showed not only more transplants as chain length increased, but also that NEAD chains produced more transplants for highly sensitized and blood type O recipients.