Characterization of waiting times in a simulation of kidney paired donation
Characterization of waiting times in a simulation of kidney paired donation
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DOI：
10.1111/j.1600-6143.2005.01048.x
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发表时间：
2005-10-01
影响因子：
8.8
通讯作者：
Montgomery, RA
中科院分区：
文献类型：
--
作者：
Segev, DL;Gentry, SE;Montgomery, RA
国家肾脏配对捐赠（KPD）计划将大大增加血型不相容或交叉配型阳性捐赠者的移植机会。具有某些血型、种族或限制的捐赠者-接受者配对似乎会比其他人等待更长的时间来匹配，尽管没有数据证实这一假设。我们模拟患者，并描述了不同血型亚组的预测等待时间，以及患者对等待时间的限制的影响。我们还比较了不同种族亚组的等待时间。在国家KPD计划中，几乎所有小组反应性抗体（PRA）低于80%的患者在几个月内匹配，O型受体与AB型供体的等待时间最长。高致敏患者等待的时间要长得多，特别是那些不愿意旅行或接受老年供体的患者，而AB或B供体的患者可能无法及时配型。尽管患者在合并的样本库中匹配比在自己的种族中匹配更好，但种族不平等仍然存在，奖励积分可以抵消其中的一些差异。这些数据提供了第一个等待时间的预测，可以帮助患者在KPD和脱敏之间进行选择，也可以促进国家KPD计划的规划。
A national kidney paired donation (KPD) program will substantially increase transplant opportunities for recipients with blood type incompatible or cross-match positive donors. It seems likely that donor-recipient pairs with certain blood types, races or restrictions will wait longer than others for a match, although no data exist to confirm this assumption. We simulated patients and characterized the predicted waiting times for different blood type sub-groups, as well as the effects of patient-imposed restrictions on waiting time. We also compared waiting times of different racial sub-groups. Almost all patients with panel-reactive antibody (PRA) less than 80% match within a few months in a national KPD program, with the longest waiting time seen by O recipients with AB donors. Highly sensitized patients wait considerably longer, especially those unwilling to travel or accept older donors, and those with AB or B donors may not match in a timely manner. Although patients are better served by matching in a combined pool than within their own race, racial inequalities exist and bonus points can offset some of these differences. These data provide the first waiting time predictions that can aid patients with incompatible donors in choosing between KPD and desensitization, and can also facilitate planning for a national KPD program.