Managing highly sensitized renal transplant candidates in the era of kidney paired donation and the new kidney allocation system: Is there still a role for desensitization?
Managing highly sensitized renal transplant candidates in the era of kidney paired donation and the new kidney allocation system: Is there still a role for desensitization?
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DOI：
10.1111/ctr.13751
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发表时间：
2019-11-26
影响因子：
2.1
通讯作者：
Stegall, Mark D.
中科院分区：
文献类型：
--
作者：
Schinstock, Carrie A.;Smith, Byron H.;Stegall, Mark D.
美国的肾脏配对捐献（KPD）和新的肾脏分配系统（KAS）提高了高致敏候选人的移植率。我们的目的是评估其他方法的潜在需求，以提高高致敏候选人的移植率，如脱敏。使用UNOS星星文件，我们分析了截至2016年6月1日的普遍活跃等待名单队列的移植率，随访1年。总移植率为18.9%（11129/58769）。然而，只有9.7%（213/2204）的候选人与计算的面板反应性抗体>= 99.9%接受移植，高度致敏的候选人不太可能接受活体供体移植。在CPRA >= 99.5%的候选人中（即100%），只有2.5%的移植来自活体供体（共13例，7例来自KPD）。在KAS（2018年6月30日）近4年后，1791名积极等待的候选人的CPRA>= 99.9%，其中34.6%（620/1791）的等待时间>= 5年。因此，尽管有KPD和KAS，许多敏感的候选人即使等待时间延长也没有移植。我们的结论是，CPRA >= 99.9%的候选人和具有不相容活体供体和延长等待时间的致敏候选人可能受益于脱敏，以提高他们接受移植的能力。
Kidney paired donation (KPD) and the new kidney allocation system (KAS) in the United States have led to improved transplantation rates for highly sensitized candidates. We aimed to assess the potential need for other approaches to improve the transplantation rate of highly sensitized candidates such as desensitization. Using the UNOS STAR file, we analyzed transplant rates in a prevalent active waiting-list cohort as of June 1, 2016, followed for 1 year. The overall transplantation rate was 18.9% (11 129/58769). However, only 9.7% (213/2204) of candidates with a calculated panel reactive antibody >= 99.9% received a transplant, and highly sensitized candidates were less likely to receive a living donor transplant. Among candidates with a CPRA >= 99.5% (ie. 100%), only 2.5% of transplants were from living donors (13 total, 7 from KPD). Nearly 4 years after KAS (6/30/2018), 1791 actively wait-listed candidates had a CPRA of >= 99.9% and 34.6% (620/1791) of these had >= 5 years of waiting time. Thus, despite KPD and KAS, many sensitized candidates have not been transplanted even with prolonged waiting time. We conclude that candidates with a CPRA >= 99.9% and sensitized candidates with an incompatible living donor and prolonged waiting time may benefit from desensitization to improve their ability to receive a transplant.