Early Changes in Kidney Distribution under the New Allocation System
Early Changes in Kidney Distribution under the New Allocation System
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DOI：
10.1681/asn.2015080934
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发表时间：
2016-08-01
影响因子：
13.6
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
--
作者：
Massie, Allan B.;Luo, Xun;Segev, Dorry L.
肾脏分配系统（KAS）是对已故捐赠者肾脏分配的重大改变，于2014年12月实施。KAS的目标包括将最高质量的器官提供给更年轻/更健康的受者，并为高度敏感的患者和种族/少数民族提供更多的死亡供体肾移植（DDKT）。使用国家登记数据，我们比较了2013年1月1日至2014年12月3日（KAS前）与2014年12月4日至2015年8月31日（KAS后）之间的肾脏分布，等待登记者的DDKT率和受体特征。区域进口从KAS前的8.8%增加到KAS后的12.5%;国家进口从KAS前的12.7%增加到KAS后的19.1%（P <0.001）。年龄大于30岁的受者比例从19.4%下降到15.0%（P <0.001）。计算的群体反应性抗体= 100的受者比例从1.0%增加到10.3%（P <0.001）。总体DDKT率没有变化，如使用指数回归调整候选特征所建模的（P = 0.07）。然而，DDKT率（发生率比，95%置信区间）黑人增加（1.19; 1.13至1.25）和西班牙裔（1.13; 1.05至1.20）候选人和18至40岁的候选人（1.47; 1.38至1.57），但50岁以上的候选人下降（0.93; 51 - 60岁的候选人为0.87至0.98，70岁以上的候选人为0.90; 0.85至0.96）。移植受者移植肾功能延迟恢复率从KAS前的24.8%增加到KAS后的29.9%（P <0.001）。因此，在KAS的前9个月，少数民族、年轻候选人和高度敏感患者获得DDKT的机会有所改善，但老年候选人的机会有所下降。移植物功能延迟显著增加，可能提示长期结局较差。
The Kidney Allocation System (KAS), a major change to deceased donor kidney allocation, was implemented in December 2014. Goals of KAS included directing the highest-quality organs to younger/healthier recipients and increasing access to deceased donor kidney transplantation (DDKT) for highly sensitized patients and racial/ethnic minorities. Using national registry data, we compared kidney distribution, DDKT rates for waitlist registrants, and recipient characteristics between January 1, 2013, and December 3, 2014 (pre-KAS) with those between December 4, 2014, and August 31, 2015 (post-KAS). Regional imports increased from 8.8% pre-KAS to 12.5% post-KAS; national imports increased from 12.7% pre-KAS to 19.1% post-KAS (P < 0.001). The proportion of recipients >30 years older than their donor decreased from 19.4% to 15.0% (P < 0.001). The proportion of recipients with calculated panel-reactive antibody =100 increased from 1.0% to 10.3% (P < 0.001). Overall DDKT rate did not change as modeled using exponential regression adjusting for candidate characteristics (P=0.07). However, DDKT rate (incidence rate ratio, 95% confidence interval) increased for black (1.19; 1.13 to 1.25) and Hispanic (1.13; 1.05 to 1.20) candidates and for candidates aged 18-40 (1.47; 1.38 to 1.57), but declined for candidates aged >50 (0.93; 0.87 to 0.98 for aged 51-60 and 0.90; 0.85 to 0.96 for aged >70). Delayed graft function in transplant recipients increased from 24.8% pre-KAS to 29.9% post-KAS (P < 0.001). Thus, in the first 9 months under KAS, access to DDKT improved for minorities, younger candidates, and highly sensitized patients, but declined for older candidates. Delayed graft function increased substantially, possibly suggesting poorer long-term outcomes.