Increasing deceased donor transplants among pediatric candidates under the revised allocation strategy in China
Increasing deceased donor transplants among pediatric candidates under the revised allocation strategy in China
复制标题
根据修订后的中国分配策略，增加了儿科候选者中死亡供体移植的数量
DOI：
10.1111/petr.13829
复制
发表时间：
2020-10
影响因子：
1.3
通讯作者：
Lei Zhang
中科院分区：
文献类型：
--
作者：
Mingxing Sui;Wenyu Zhao;Youhua Zhu;Li Zeng;Lei Zhang
Dear Editors, Before 2010 in China, few transplant centers were ready to accept the challenge of PKT due to the sparse organ source and complex clinical management, especially in the low-weight children who need PKTs the most. With the development of surgical techniques and the trend in improving children's welfare, the NHC, then the Chinese Ministry of Health) implemented the basic Principles of Chinese Human Organ Distribution and Sharing in 2010 that promoted the PCs preferential access to deceased donor kidney transplants,1 which contributed to 247 deceased donor PKTs from 2010 to 20122 (Figure 1). The policy was a significant breakthrough, yet there were substantial opportunities for further enhancements when compared to the 2263 PKTs performed in the United States during approximately the same period.3 The leading reasons were the insufficient supply of high-quality donor kidneys and the geographical barriers. PCs could only register in several transplant centers, which were experienced but generated a relatively inadequate supply of high-quality donor kidneys. And the high-quality donor kidneys from other geographic centers were first allocated to the local candidates because geographical location took priority over age. On the other hand, we noticed that there was a high discard rate of pediatric donor kidneys (PDKs) that were conventionally considered marginal.4 In 2006, our center first used PDKs for low-body weight female adult recipients in China, and the short-term result exceeded expectations and showed promising long-term outcomes, indicating that PDKs were a severely underutilized potential transplantation source as long as they were matched properly. This positive result encouraged us to further explore the feasibility of using PDKs in PCs starting in 2012. Gradually, we developed the weight-matched “pediatric to pediatric” mode (PTP mode). In 2014, we published the short-term data of 95 patients treated under the PTP mode and recommended the PTP mode to the Chinese kidney transplant community. We later expanded the PTP mode to be implemented in several large transplant centers in China starting in 2015.5 It was shown that the PTP mode made better utilization of the PDKs and markedly increased the number of PKTs to over 200 per year by 2018 (Figure 1), even though the PTP mode had only been adopted in several transplant hospitals for fewer than 3 years. Most of the PDKs could be discarded in other countries in accordance with the poor kidney donor profile index results. Of the 87 pediatric donors in our center, only one donor's kidneys were optimal. However, after a mean follow-up time of 46.2 months, the patient survival rate was 96.77% (120/124), and the graft survival rate was 91.13% (113/124). We believed that the PDKs were labeled “marginal” due to allocation mismatch. Due to the evident substantial improvement in pediatric transplantation, on July 12, 2018, the NHC revised its policy and reemphasized the pediatric priority, highlighting that PDKs should be first allocated to PCs under the PTP mode across the nation regardless of geographic location. One year after this revision, 337 PDKs were performed nationwide,2 suggesting that this revised allocation strategy in China confers significant benefits on PCs (Figure 1). We herein share our experience with the international transplant community, and we believe that PTP mode held reference value for the other allocation systems.
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影响因子：
6.1
作者：
Abramowicz, Daniel;Cochat, Pierre;Nagler, Evi
通讯作者：
Nagler, Evi
DOI：
10.2478/mmr-2014-0001
发表时间：
2015-11
期刊：
Macedonian Medical Review
影响因子：
--
作者：
G. Spasovski;P. Cochat;Frans Hj Claas;U. Heemann;J. Pascual;Chris Dudley;P. Harden;M. Hourmant;U. Maggiore;M. Salvadori;J. Squifflet;J. Steiger;Armando Torres;O. Viklicky;M. Zeier;R. Vanholder;W. van Biesen;E. Nagler;D. Abramowicz
通讯作者：
G. Spasovski;P. Cochat;Frans Hj Claas;U. Heemann;J. Pascual;Chris Dudley;P. Harden;M. Hourmant;U. Maggiore;M. Salvadori;J. Squifflet;J. Steiger;Armando Torres;O. Viklicky;M. Zeier;R. Vanholder;W. van Biesen;E. Nagler;D. Abramowicz
影响因子：
1.3
作者：
Sui, Mingxing;Zhao, Wenyu;Zhang, Lei
通讯作者：
Zhang, Lei
影响因子：
168.9
作者：
Huang, Jiefu;Millis, J. Michael;Zhong, Shouxian
通讯作者：
Zhong, Shouxian