OPTN/SRTR 2019 Annual Data Report: Kidney
OPTN/SRTR 2019 Annual Data Report: Kidney
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DOI：
10.1111/ajt.16502
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发表时间：
2021-02-01
影响因子：
8.8
通讯作者：
Snyder, J. J.
中科院分区：
文献类型：
--
作者：
Hart, A.;Lentine, K. L.;Snyder, J. J.
尽管相对于有需要的候选人，可用的肾脏移植物持续严重短缺，但2019年的数据显示了一些有希望的趋势。在多年相对停滞之后，肾脏移植数量自2015年以来每年都在增加，2019年达到迄今为止的最高年度数量24，273。尽管2019年新增的候选人数量有所增加，且因死亡或病情恶化而从等待名单中移除的患者数量有所减少，但美国等待肾移植的患者数量相对稳定。然而，这些令人鼓舞的趋势受到持续挑战的影响。在全国范围内，只有四分之一的等待患者在5年内接受了死亡供体肾移植，这一比例因捐赠服务地区而异，从15.5%到67.8%。回收器官的未利用率（丢弃率）保持在20.1%，尽管丙型肝炎阳性供体的器官丢弃率显著下降。对于肾脏捐献者概况指数>= 85%的肾脏和获得活检标本的肾脏，未利用率仍然特别高。虽然活体移植的数量在2019年再次增加，但每年只有一小部分等待名单接受活体移植，而且活体移植的种族差异仍然存在。随着移植物和患者存活率的不断提高，在未来1-2年内，具有功能性移植物的活体肾移植受者的总数预计将超过250，000。在过去的十年中，儿科肾移植的总数保持稳定。尽管做出了许多努力，活体供肾移植在儿科受者中仍然很低，受者之间存在持续的种族差异。肾脏和泌尿道的先天性异常仍然是肾脏疾病的主要原因。虽然大多数死亡的供体受体从KDPI小于35%的供体接受肾脏，但大多数儿科受体具有四个或更多个HLA错配。移植物存活率继续提高，活体供体受体的结局上级。
Despite the ongoing severe shortage of available kidney grafts relative to candidates in need, data from 2019 reveal some promising trends. After remaining relatively stagnant for many years, the number of kidney transplants has increased each year since 2015, reaching the highest annual count to date of 24,273 in 2019. The number of patients waiting for a kidney transplant in the United States was relatively stable, despite an increase in the number of new candidates added in 2019 and a decrease in patients removed from the waiting list owing to death or deteriorating medical condition. However, these encouraging trends are tempered by ongoing challenges. Nationwide, only a quarter of waitlisted patients receive a deceased-donor kidney transplant within 5 years, and this proportion varies dramatically by donation service area, from 15.5% to 67.8%. The non-utilization (discard) rate of recovered organs remains at 20.1%, despite adramatic decline in the discard of organs from hepatitis C-positive donors. Non-utilization rates remain particularly high for Kidney Donor Profile Index >= 85% kidneys and kidneys from which a biopsy specimen was obtained. While the number of living-donor transplants increased again in 2019, only a small proportion of the waiting list receives living-donor transplants each year, and racial disparities in living-donor transplant access persist. As both graft and patient survival continue to improve incrementally, the total number of living kidney transplant recipients with a functioning graft is anticipated to exceed 250,000 in the next 1-2 years. Over the past decade, the total number of pediatric kidney transplants performed has remained stable. Despite numerous efforts, living donor kidney transplant remains low among pediatric recipients with continued racial disparities among recipients. Congenital anomalies of the kidney and urinary tract remain the leading cause of kidney disease. While most deceased donor recipients receive a kidney from a donor with KDPI less than 35%, the majority of pediatric recipients had four or more HLA mismatches. Graft survival continues to improve with superior outcomes for living donor recipients.