Impact of the new kidney allocation system A2/A2B → B policy on access to transplantation among minority candidates.
Impact of the new kidney allocation system A2/A2B → B policy on access to transplantation among minority candidates.
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DOI：
10.1111/ajt.14719
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发表时间：
2018-08
期刊：
影响因子：
--
通讯作者：
Locke JE
中科院分区：
文献类型：
--
作者：
Martins PN;Mustian MN;MacLennan PA;Ortiz JA;Akoad M;Caicedo JC;Echeverri GJ;Gray SH;Lopez-Soler RI;Gunasekaran G;Kelly B;Mobley CM;Black SM;Esquivel C;Locke JE
血型B的候选人，其中许多人代表少数民族，历史上已经减少了获得死者供体肾移植（DDKT）。新的国家肾脏分配系统（KAS）优先将A2/A2 B血型的已故供体肾脏分配给B受体，以解决这种种族和血型差异。尚未有研究检查KAS对总体或少数群体B血型受者A2不相容（A2 i）DDKT的影响。根据移植受体科学登记处的报告，对2013-2017年的成人B DDKT血型受体进行了病例对照研究。病例被定义为A2/A2 B肾的受体，而对照组则是所有剩余的非A2/A2 B肾的受体。使用多变量logistic回归比较了KAS前（2013年1月1日-2014年12月3日）与KAS后（2014年12月4日-2017年2月28日）的A2 i DDKT趋势。与KAS前相比，KAS后A2 i DDKT的可能性增加了4.9倍（OR 4.92，95% CI：3.67-6.60）。然而，与白人相比，KAS后少数民族A2 i DDKT的可能性没有差异。尽管KAS导致A2/A2 B →B DDKT增加，但相对于白人，少数民族中A2 i DDKT的可能性并未改善。有必要进一步讨论旨在改善少数民族获得DDKT的A2/A2 B →B政策修订。
Blood group B candidates, many of whom represent ethnic minorities, have historically had diminished access to deceased donor kidney transplantation (DDKT). The new national kidney allocation system (KAS) preferentially allocates blood group A2/A2B deceased donor kidneys to B recipients to address this ethnic and blood group disparity. No study has yet examined the impact of KAS on A2 incompatible (A2i) DDKT for blood group B recipients overall or among minorities. A case-control study of adult blood group B DDKT recipients from 2013–2017 was performed, as reported to the Scientific Registry of Transplant Recipients. Cases were defined as recipients of A2/A2B kidneys, whereas controls were all remaining recipients of non-A2/A2B kidneys. A2i DDKT trends were compared from the pre-KAS (1/1/2013–12/3/2014) to the post-KAS period (12/4/2014–2/28/2017) using multivariable logistic regression. Post-KAS, there was a 4.9-fold increase in the likelihood of A2i DDKT, compared to the pre-KAS period (OR 4.92, 95% CI: 3.67–6.60). However, compared to whites, there was no difference in the likelihood of A2i DDKT among minorities post-KAS. Although KAS resulted in increasing A2/A2B→B DDKT, the likelihood of A2i DDKT among minorities, relative to whites, was not improved. Further discussion regarding A2/A2B→B policy revisions aimed to improve DDKT access for minorities is warranted.
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