Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System
Historical Matching Strategies in Kidney Paired Donation: The 7-Year Evolution of a Web-Based Virtual Matching System
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DOI：
10.1111/ajt.13337
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发表时间：
2015-10-01
影响因子：
8.8
通讯作者：
Rees, M. A.
中科院分区：
文献类型：
--
作者：
Fumo, D. E.;Kapoor, V.;Rees, M. A.
未能将计算机识别的可能的肾脏配对捐赠 (KPD) 交换转化为移植，导致 KPD 无法充分发挥其潜力。这项研究分析了从“要约”到完成移植的交换进展情况。为了计算成功率，要约被分为称为单向移植的各个部分。从 2007 年到 2014 年，配对捐赠联盟进行了 243 例移植，其中 31 例与其他 KPD 登记处合作，194 例独立进行。194 例独立移植中的 61 例 (31.4%) 通过周期进行，其余的则进行了移植。 133 个 (68.6%) 来自非同时扩展利他捐赠者 (NEAD) 链，其中 35 个 (37.1%) 具有至少三个 NEAD 片段的 NEAD 链占链移植的 68%（8.6 笔/链），“报价”和单向成功率分别为 21.9% 和 15.5%。发现失败的三个原因可以通过改变方案或软件来预防：阳性实验室交叉配血（28%）、移植中心拒绝供体（17%）和在 APD 之外进行配对移植（14%）。对从提供到移植的失败进行根本原因分析使 APD 能够改进协议和软件。这些变化提高了每年移植的成功率和数量。
Failure to convert computer-identified possible kidney paired donation (KPD) exchanges into transplants has prohibited KPD from reaching its full potential. This study analyzes the progress of exchanges in moving from "offers'' to completed transplants. Offers were divided into individual segments called 1-way transplants in order to calculate success rates. From 2007 to 2014, the Alliance for Paired Donation performed 243 transplants, 31 in collaboration with other KPD registries and 194 independently. Sixty-one of 194 independent transplants (31.4%) occurred via cycles, while the remaining 133 (68.6%) resulted from nonsimultaneous extended altruistic donor (NEAD) chains. Thirteen of 35 (37.1%) NEAD chains with at least three NEAD segments accounted for 68% of chain transplants (8.6 tx/chain). The "offer'' and 1-way success rates were 21.9 and 15.5%, respectively. Three reasons for failure were found that could be prospectively prevented by changes in protocol or software: positive laboratory crossmatch (28%), transplant center declined donor (17%) and pair transplanted outside APD (14%). Performing a root cause analysis on failures in moving from offer to transplant has allowed the APD to improve protocols and software. These changes have improved the success rate and the number of transplants performed per year.