The Author's Reply: Improving Functional Status Reporting may Save Patient Lives and Reduce Kidney Discard.
The Author's Reply: Improving Functional Status Reporting may Save Patient Lives and Reduce Kidney Discard.
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作者的回复：改进功能状态报告可以挽救患者的生命并减少肾脏废弃。
DOI：
10.1097/tp.0000000000002927
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发表时间：
2020
期刊：
影响因子：
6.2
通讯作者：
Mehrotra,Sanjay
中科院分区：
文献类型：
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作者：
Mehrotra,Sanjay
我们赞赏Kasiske等人在他们的信中提供的移植结果模型中使用患者功能状态和Karnofsky性能量表（KPS）评分的历史观点。1还注意到，在报告KPS评分方面，各方案之间差异很大，其衡量缺乏一致性。然而，KPS是一个重要的协变量，它可以全面了解患者的健康状况，而不仅仅是对其生物学和人口统计学变量的评估。人们认为科索沃警察部队的报告/误报可归因于多种因素，其中只有一个因素是“玩弄”制度。即使在系统中有玩家可能“玩游戏”，社区也希望阻止这种游戏的发生。适当报告患者健康状况可被视为移植系统专业人员医学伦理教育的一部分。这一点特别重要，因为使用KPS评分的适当校准模型，分析表明，肾脏供体特征指数（KDPI）评分最高的肾脏具有良好的结局，即使是KPS评分最低的患者。2在美国，大部分高KDPI肾脏被丢弃。对于KPS评分低的患者，透析的预期生存率非常低，因此这些患者可以从高KDPI肾脏中获益，而不是将其丢弃。
We appreciate the historical perspective on using patient functional status and the Karnofsky Performance Scale (KPS) score in the transplant outcome models provided by Kasiske et al in their letter. 1 The observation that there is a large program-to-program variation in reporting of the KPS score and a lack of consistency in its measurement is also noted. Nevertheless, the KPS is an important covariate that captures a holistic view of a patient’s health status that goes beyond the evaluation of their biologic and demographic variables. The perceived reporting/misreporting of KPS can be attributed to a variety of factors, only one of which could be “gaming” the system. Even if there are players in the system that might “game,” it is desirable of the community that it prevents such gaming from happening. Proper reporting of patient health status may be considered as part of the medical ethics education for the professionals in the transplant system. This is particularly important because with appropriately calibrated models using KPS scores, analyses show that kidneys in the highest Kidney Donor Profile Index (KDPI) score group have a favorable outcome, even for the patients in the lowest KPS score group. 2 In the United States, a large fraction of the high KDPI kidneys are being discarded. With a very low expected survival on dialysis for patients with a low KPS score, such patients can benefit from high KDPI kidneys instead of getting them discarded.