Turn down for what? Patient outcomes associated with declining increased infectious risk kidneys
Turn down for what? Patient outcomes associated with declining increased infectious risk kidneys
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DOI：
10.1111/ajt.14577
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发表时间：
2018-03-01
影响因子：
8.8
通讯作者：
Segev, Dorry L.
中科院分区：
文献类型：
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作者：
Bowring, Mary G.;Holscher, Courtenay M.;Segev, Dorry L.
接受标记为疾病传播风险增加 (IRD) 的肾脏的移植候选人接受窗口期感染的风险较低，但那些拒绝的人必须等待另一个可能存在其他风险的报价，甚至永远不会来。为了描述接受 IRD 肾脏的生存益处，我们使用 2010-2014 年移植受者科学登记数据来确定 104998 名接受 IRD 肾脏的成人移植候选者，这些候选者最终被某人接受；这些肾脏的肾脏捐赠者概况指数 (KDPI) 中位数（四分位距）为 30 (16-49)。我们从做出录取决定开始一直跟踪患者，直到患者死亡或研究结束。 5 年后，只有 31.0% 拒绝 IRD 的候选人后来接受了非 IRD 已故捐献肾移植；这些非 IRD 肾脏的 KDPI 中位数为 52，而 IRD 肾脏的 KDPI 中位数下降了 21。在接受 IRD 后的前 30 天内经历短暂的风险期（调整后风险比 [aHR] 接受与拒绝：(1.22)2.06(3.49)，P=.008）（绝对死亡率 0.8% 对比 0.4%），接受 IRD 的患者在做出决定后 1-6 个月的死亡风险降低了 33% (aHR(0.50)0.67(0.90)，P=0.006)，决策后 6 个月后死亡风险降低 48% (aHR (0.46)0.52(0.58)，P
Transplant candidates who accept a kidney labeled increased risk for disease transmission (IRD) accept a low risk of window period infection, yet those who decline must wait for another offer that might harbor other risks or never even come. To characterize survival benefit of accepting IRD kidneys, we used 2010-2014 Scientific Registry of Transplant Recipients data to identify 104998 adult transplant candidates who were offered IRD kidneys that were eventually accepted by someone; the median (interquartile range) Kidney Donor Profile Index (KDPI) of these kidneys was 30 (16-49). We followed patients from the offer decision until death or end-of-study. After 5years, only 31.0% of candidates who declined IRDs later received non-IRD deceased donor kidney transplants; the median KDPI of these non-IRD kidneys was 52, compared to 21 of the IRDs they had declined. After a brief risk period in the first 30days following IRD acceptance (adjusted hazard ratio [aHR] accept vs decline: (1.22)2.06(3.49), P=.008) (absolute mortality 0.8% vs. 0.4%), those who accepted IRDs were at 33% lower risk of death 1-6months postdecision (aHR(0.50)0.67(0.90), P=.006), and at 48% lower risk of death beyond 6months postdecision (aHR (0.46)0.52(0.58), P