Impact of Geographic Boundaries on Deceased Donor Kidney Discard, Allocation, and Outcomes

地理边界对已故捐献者肾脏丢弃、分配和结果的影响

• 批准号: 10301901
• 负责人: Vishnu Sagar Potluri
• 金额: $ 16.91万
• 依托单位: UNIVERSITY OF PENNSYLVANIA
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-09-02 至 2026-07-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10301901
• 关键词: Accounting; Affect; American; Appointment; Area; Beds; Clinical; Data; End stage renal failure; Epidemiology; Faculty; Fostering; Funding; Geographic Locations; Geography; Goals; Grant; Health; Health Service Area; Hospitals; Improve Access; Kidney; Kidney Diseases; Kidney Transplantation; Lead; Location; Logistics; Low income; Maps; Mentorship; Methods; Minority; Minority Access; Nephrology; Organ; Organ Donations; Organ Donor; Outcome; Patients; Pattern; Pennsylvania; Physicians; Policies; Population; Prevalence; Probability; Public Health; Radial; Research; Resources; Risk; Role; Schedule; Scientist; Socioeconomic Status; System; Time; Transplant Recipients; Transplantation; United Network for Organ Sharing; Universities; Variant; Vulnerable Populations; Wait Time; base; career; data registry; design; experience; geographic difference; improved; innovation; insight; kidney allograft; novel; organ allocation; patient population; residence; transplant registry; years of life lost

PROJECT SUMMARY For the nearly 95,000 people currently waiting for a kidney transplant, their geographic residence has a major impact on whether they will get a transplant. Organ allocation is based on geographic boundaries of donor service areas (DSA) that are artificial. There are 58 DSA in the US, and they vary tremendously in size and population, which explains some of the variation in access to transplantation. The geographic boundaries of DSAs were never designed to optimize organ allocation, and do not account for population, prevalence of kidney disease, or organ donation rates. These geographic boundaries might also contribute to another important problem – unnecessary discard of donated kidneys. Nearly 20% of all kidneys donated in the US are discarded. Improving access to transplant and reducing kidney discard are national priorities under the “Advancing American Kidney Health Initiative.” A new kidney allocation policy that does not use any fixed geographic boundaries is scheduled for implementation in December 2020. However, the new organ allocation policy may have unintended effects on organ outcomes and worsen disparities in access to transplant. This grant will examine three eras of kidney allocation that reveal how the use of geographic boundaries has affected transplant benefits and equity for patients with end-stage kidney disease: 1) Historical Allocation Era: Transplants performed before 12/4/2014, when kidneys procured within a DSA were allocated primarily to recipients within the same DSA; 2) Kidney Allocation System Era (split into two sub eras): Kidneys considered “lower quality” were shared over a wider region until 9/5/2019, and this policy was subsequently reversed due to high kidney discard rates; 3) Concentric Circle Era: This system is scheduled for implementation on 12/15/2020 and eliminates DSA boundaries, and uses a 250-nautical mile radius around donor hospital to allocate kidneys. The overall objective of this scientific proposal is to determine the effects of wider geographic sharing of deceased donor kidneys on the specific outcomes of kidney discard, disparities in access to transplant, and recipient outcomes. My central hypothesis is that systems with wider sharing of deceased donor kidneys might reduce geographic inequities for patients living in areas with high wait-times, but it will worsen organ discard and fail to improve kidney allograft survival. These novel insights into the relationship between geography and kidney allocation could ultimately drive major public health gains for patients with kidney disease by showing how kidneys can be allocated to improve fairness and increase the number of transplants. The applicant has an appointment on the junior faculty at the University of Pennsylvania. With the support of a highly experienced mentorship team and the ample resources available at the University of Pennsylvania, his goal is to foster a career of enduring research as an R01 funded independent physician scientist, and to become a leader in the field of nephrology and kidney transplantation.

项目总结 对于目前等待肾脏移植的近9.5万人来说，他们的地理住所有一个 对他们是否会接受移植有重大影响。器官分配是基于地理边界的 捐赠者服务区(DSA)是人工的。美国有58个DSA，它们的大小千差万别 和人口，这解释了移植机会的一些差异。地理界线 的DSA从来没有被设计来优化器官分配，也没有考虑到人口，流行 肾脏疾病，或器官捐赠率。这些地理边界也可能导致另一个 重要的问题--不必要地丢弃捐赠的肾脏。在美国捐赠的所有肾脏中，近20%是 被丢弃了。改善移植机会和减少肾脏丢弃是国家优先事项 “推进美国肾脏健康倡议。”新的肾脏分配策略不使用任何固定的 《地理界线》计划于2020年12月实施。然而，新的器官分配 政策可能会对器官结果产生意想不到的影响，并加剧获得移植机会的差距。 这笔赠款将研究肾脏分配的三个时代，揭示如何使用地理 边界影响了终末期肾病患者的移植益处和公平性：1)历史 分配时代：移植是在2014年12月4日之前进行的，当时在DSA内获得的肾脏被分配 主要提供给同一DSA内的受赠者；2)肾脏分配系统时代(分成两个子时代)：肾脏 在2019年9月5日之前，被认为“质量较低”的产品在更大范围内共享，这一政策随后被 由于肾脏丢弃率高而逆转；3)同心圆时代：该系统计划用于 在2020年12月15日实施，消除了DSA边界，并使用250海里半径周围 捐赠者医院分配肾脏。这项科学提案的总体目标是确定 关于肾脏丢弃的具体结果，已故供者肾脏在地理上的更广泛共享， 获得移植的机会，以及受者的结果。我的中心假设是具有更广泛共享的系统 已故的供者肾脏可能会减少居住在等待时间较长地区的患者的地理不平等， 但它会恶化器官丢弃，无法提高移植肾的存活率。这些新奇的洞察 地理位置和肾脏分配之间的关系最终可能推动以下方面的重大公共健康收益 通过展示如何分配肾脏来提高公平性和增加肾脏疾病患者的 移植的数量。 申请者预约了宾夕法尼亚大学初级教员的职位。与 经验丰富的指导团队的支持和牛津大学丰富的资源 宾夕法尼亚州，他的目标是作为一名R01资助的独立医生培养一份持久研究的职业生涯 科学家，并成为肾脏病和肾移植领域的领导者。