The Extent and Predictors of Waiting Time Geographic Disparity in Kidney Transplantation in the United States
The Extent and Predictors of Waiting Time Geographic Disparity in Kidney Transplantation in the United States
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DOI：
10.1097/01.tp.0000438623.89310.dc
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发表时间：
2014-05-27
期刊：
影响因子：
6.2
通讯作者：
Ladner, Daniela P.
中科院分区：
文献类型：
--
作者：
Davis, Ashley E.;Mehrotra, Sanjay;Ladner, Daniela P.
背景。美国各地对已故捐献者肾移植的等待时间差异很大。这种变化违反了最终规则，即联邦命令，该规则要求移植器官分配的地域公平性。方法。对美国肾脏数据系统和联合器官共享网络数据库2000年至2009年的回顾性分析。计算了美国58个捐献者服务区（DSA）的中位等待时间。进行多变量回归以确定肾移植等待时间较长的 DSA 预测因子。结果。 58 个 DSA 的等待时间中位数从 0.61 年到 4.57 年不等，标准标准供肾的等待时间为 0.59 年到 5.17 年，扩展标准供肾的等待时间为 0.41 年到 4.69 年。各DSA等待时间的差距从2000年的3.26年（范围0.41-3.67）扩大到2009年的4.72年（范围0.50-5.22）。在等待时间较长的DSA中，患有终末期肾病的患者明显增多，申请肾移植的患者也明显增多，肾脏获取率较低，移植中心的竞争也加剧。患者更有可能是黑人、敏感、受教育程度较低，并且不太可能在居住地 DSA 之外等候。等待时间较长的 DSA 中使用的供体器官更有可能呈丙型肝炎阳性，并且具有较高的肾脏供体概况指数。对于已故供体肾移植，移植物和患者的 5 年生存率较差，但活体供体肾移植的比率较高。结论。我们的分析表明，各 DSA 的肾移植等待时间存在显着且日益恶化的地理差异。活体肾移植和边缘器官使用的增加并没有缩小这一差距。可能需要改变肾脏分配系统来解决肾脏分配中广泛的地理差异。
Background. Waiting time to deceased donor kidney transplant varies greatly across the United States. This variation violates the final rule, a federal mandate, which demands geographic equity in organ allocation for transplantation.Methods. Retrospective analysis of the United States Renal Data System and United Network for Organ Sharing database from 2000 to 2009. Median waiting time was calculated for each of the 58 donor service areas (DSA) in the United States. Multivariate regression was performed to identify DSA predictors for long waiting times to kidney transplantation.Results. The median waiting time varied between the 58 DSAs from 0.61 to 4.57 years, ranging from 0.59 to 5.17 years for standard criteria donor kidneys and 0.41 to 4.69 years for expanded criteria donor kidneys. The disparity in waiting time between the DSAs grew from 3.26 years (range, 0.41-3.67) in 2000 to 4.72 years (range, 0.50-5.22) in 2009. In DSAs with longer waiting times, there were significantly more patients suffering from end-stage renal disease and more patients listed for kidney transplant, lower kidney procurement rates, and higher transplant center competition. Patients were more likely black, sensitized, with lower educational attainment and less likely to waitlist outside of their DSA of residence. Donor organs used in DSAs with long waiting times were more likely hepatitis C positive and had a higher kidney donor profile index. Graft and patient survival at 5 years was worse for deceased donor kidney transplant, but rates for living donor kidney transplant were higher.Conclusion. Our analysis demonstrates significant and worsening geographic disparity in waiting time for kidney transplant across the DSAs. Increase in living donor kidney transplant and use of marginal organs has not mitigated the disparity. Changes to the kidney allocation system might be required to resolve this extensive geographic disparity in kidney allocation.