Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival.
Regional Disparities in Transplantation With Deceased Donor Kidneys With Kidney Donor Profile Index Less Than 20% Among Candidates With Top 20% Estimated Post Transplant Survival.
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DOI：
10.1177/1526924819874699
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发表时间：
2019-12
期刊：
影响因子：
--
通讯作者：
Mohan S
中科院分区：
文献类型：
--
作者：
Husain SA;King KL;Dube GK;Tsapepas D;Cohen DJ;Ratner LE;Mohan S
美国的肾脏分配系统优先考虑移植后存活率(≤)估计为20%的候选人，以便接受肾脏捐赠者概况指数(KDPI)≤为20%的已故供者肾脏。我们比较了全美20%EPTS≤候选患者获得KDPI20%肾脏的可能性，以确定是否存在获得这些低KDPI20%肾脏的地理差异。我们使用联合器官共享网络的数据确定了2015年1月1日至2018年3月31日等待名单上的所有事件成人已故捐赠者肾脏候选人。我们计算了受试者的移植比例、最终受试者的受试率和移植肾的KDPI，≤分别为20%和20%。我们使用Logistic回归分析比较了不同地区接受KDPI≤20%的死亡供体肾的几率和接受20%EPTS≤的几率。在121069名已故供肾候选人中，28.5%的人有列出的EPTS≤20%。在这些患者中，16.1%接受了已故供者肾移植(候选人列出了EPTS和GT；20%：17.1%接受了移植)，12.3%失去了EPTS≤20%的状态。只有49.4%的受者在移植时得到了KDPI≤20%的肾，而48.3%的KDPI≤20%的肾脏移植给了EPTS>；20%的受者。接受KDPI≤为20%的肾脏的赔率在第6区最高，在第9区最低(优势比0.19[0.13比0.28])。KDPI≤20%供者/EPTS≤20%供者比例与KDPI≤20%移植可能性显著相关(R2=0.84)。在接受KDPI≤20%的已故供者肾移植的可能性中，有20%的候选移植EPTS≤存在明显的地理差异，这与分配范围内器官可获得性的差异有关。需要改变政策以改善器官共享，以改善获得低KDPI肾脏的公平性。
The Kidney Allocation System in the United States prioritizes candidates with Estimated Post-Transplant Survival (EPTS) ≤20% to receive deceased donor kidneys with Kidney Donor Profile Index (KDPI) ≤20%. We compared access to KDPI ≤ 20% kidneys for EPTS ≤ 20% candidates across the United States to determine whether geographic disparities in access to these low KDPI kidneys exist. We identified all incident adult deceased donor kidney candidates wait-listed January 1, 2015, to March 31, 2018, using United Network for Organ Sharing data. We calculated the proportion of candidates transplanted, final EPTS, and KDPI of transplanted kidneys for candidates listed with EPTS ≤ 20% versus >20%. We compared the odds of receiving a KDPI ≤ 20% deceased donor kidney for EPTS ≤ 20% candidates across regions using logistic regression. Among 121 069 deceased donor kidney candidates, 28.5% had listing EPTS ≤ 20%. Of these, 16.1% received deceased donor kidney transplants (candidates listed EPTS > 20%: 17.1% transplanted) and 12.3% lost EPTS ≤ 20% status. Only 49.4% of transplanted EPTS ≤ 20% candidates received a KDPI ≤ 20% kidney, and 48.3% of KDPI ≤ 20% kidneys went to recipients with EPTS > 20% at the time of transplantation. Odds of receiving a KDPI ≤ 20% kidney were highest in region 6 and lowest in region 9 (odds ratio 0.19 [0.13 to 0.28]). The ratio of KDPI ≤ 20% donors per EPTS ≤ 20% candidate and likelihood of KDPI ≤ 20% transplantation were strongly correlated (r2 = 0.84). Marked geographic variation in the likelihood of receiving a KDPI ≤ 20% deceased donor kidney among transplanted EPTS ≤ 20% candidates exists and is related to differences in organ availability within allocation borders. Policy changes to improve organ sharing are needed to improve equity in access to low KDPI kidneys.
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DOI：
10.1111/ajt.14622
发表时间：
2018-06
期刊：
American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons
影响因子：
--
作者：
Zhou S;Massie AB;Luo X;Ruck JM;Chow EKH;Bowring MG;Bae S;Segev DL;Gentry SE
通讯作者：
Gentry SE
影响因子：
8.8
作者：
Mathur, A. K.;Ashby, V. B.;Wolfe, R. A.
通讯作者：
Wolfe, R. A.
影响因子：
6.2
作者：
Davis, Ashley E.;Mehrotra, Sanjay;Ladner, Daniela P.
通讯作者：
Ladner, Daniela P.
影响因子：
120.7
作者：
Merion, RM;Ashby, VB;Port, FK
通讯作者：
Port, FK
DOI：
10.2215/cjn.05350513
发表时间：
2014-08-01
影响因子：
9.8
作者：
Davis, Ashley E.;Mehrotra, Sanjay;Ladner, Daniela P.
通讯作者：
Ladner, Daniela P.