Kidney Paired Donation Chains Initiated by Deceased Donors.
Kidney Paired Donation Chains Initiated by Deceased Donors.
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DOI：
10.1016/j.ekir.2022.03.023
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发表时间：
2022-06
影响因子：
6
通讯作者：
Kalbfleisch, John D.
中科院分区：
文献类型：
--
作者：
Wang, Wen;Leichtman, Alan B.;Rees, Michael A.;Song, Peter X. -K.;Ashby, Valarie B.;Shearon, Tempie;Kalbfleisch, John D.
关键词：
与其通过直接捐赠给等待名单上的候选人来产生1次移植，已故捐赠者(DDS)可以通过捐赠给肾脏配对捐赠(KPD)池中的候选人来实现额外的移植，从而启动以活着捐赠者(LD)捐赠给等待名单上的候选人结束的连锁反应。我们模拟了各种战略产生的结果，这些战略允许DDS启动KPD链。我们基于2016至2017年实际的美国DD和等待名单数据进行模拟，并使用模拟的KPD池来模拟DD启动的KPD链。我们还考虑了评估和克服这种方法的主要批评的方法，即潜在的劣势O型血等待名单的候选人。与较短的DD启动的KPD链相比，较长的链将KPD移植的数量增加高达5%，并将分配给KPD池的DD数量减少25%。这些策略增加了O型血移植的总数，并使等待名单上的候选人可以获得LDS。限制O型DDS的分配，以要求终止具有LD O型血型捐献的KPD链到等待名单，显著减少KPD移植的数量。分配不到3%的DD来启动KPD链可以每年增加多达290例肾移植。这种DDS的使用允许高度致敏的O型KPD候选患者的额外移植。总的来说，每种血型的患者，包括O型血，都将从拟议的策略中受益。
Rather than generating 1 transplant by directly donating to a candidate on the waitlist, deceased donors (DDs) could achieve additional transplants by donating to a candidate in a kidney paired donation (KPD) pool, thereby, initiating a chain that ends with a living donor (LD) donating to a candidate on the waitlist. We model outcomes arising from various strategies that allow DDs to initiate KPD chains. We base simulations on actual 2016 to 2017 US DD and waitlist data and use simulated KPD pools to model DD-initiated KPD chains. We also consider methods to assess and overcome the primary criticism of this approach, namely the potential to disadvantage blood type O-waitlisted candidates. Compared with shorter DD-initiated KPD chains, longer chains increase the number of KPD transplants by up to 5% and reduce the number of DDs allocated to the KPD pool by 25%. These strategies increase the overall number of blood type O transplants and make LDs available to candidates on the waitlist. Restricting allocation of blood type O DDs to require ending KPD chains with LD blood type O donations to the waitlist markedly reduces the number of KPD transplants achieved. Allocating fewer than 3% of DD to initiate KPD chains could increase the number of kidney transplants by up to 290 annually. Such use of DDs allows additional transplantation of highly sensitized and blood type O KPD candidates. Collectively, patients of each blood type, including blood type O, would benefit from the proposed strategies.
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DOI：
10.1111/ajt.16268
发表时间：
2021-01
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：
通讯作者：
--
影响因子：
1
作者：
Li, Yijiang;Song, Peter X. -K.;Kalbfleisch, John D.
通讯作者：
Kalbfleisch, John D.
影响因子：
168.9
作者：
Montgomery, Robert A.;Gentry, Sommer E.;Segev, Dorry L.
通讯作者：
Segev, Dorry L.
DOI：
10.1111/ajt.14744
发表时间：
2018-11
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：
Flechner SM;Thomas AG;Ronin M;Veale JL;Leeser DB;Kapur S;Peipert JD;Segev DL;Henderson ML;Shaffer AA;Cooper M;Hil G;Waterman AD
通讯作者：
Waterman AD
影响因子：
13.7
作者：
Roth, AE;Sönmez, T;Ünver, MU
通讯作者：
Ünver, MU