Xingyu Zhang,Vishnu S Potluri,Michele Molinari,Osea Giuntella,Sundaram Hariharan,Chethan M Puttarajappa
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引用次数: 0
Abstract
A new deceased donor kidney allocation system (KAS250) was implemented in March 2021 that prioritizes recipients within a 250 nautical mile radius from the donor hospital. KAS250 was implemented to reduce geographic disparities in access to kidney transplantation. Studies have shown an increase in cold ischemia time (CIT) after KAS250 implementation but the impact on graft outcomes is unknown. Utilizing data from the Scientific Registry of Transplant Recipients, we estimated cause-specific hazards of 1-year death-censored graft loss (DCGL) and all-cause graft loss (ACGL) due to KAS250 for the post-KAS250 period (April 2021 to December 2022; N=28,584) compared to the pre-KAS250 period (January 2017 to December 2018; N=23,798). We found that the post-KAS250 period had higher DCGL (Hazard ratio 1.14; 95% CI 1.02-1.26; p=0.0187) and ACGL (Hazard ratio 1.22; 95% CI 1.13-1.31, p<.0001). Mediation analysis showed that CIT indirectly mediated 45.54% and 15.73% of KAS250 policy's effect on DCGL and ACGL, respectively. In conclusion, short-term graft outcomes in the post-KAS250 era are inferior to those in the pre-KAS250 era, with the worsening CIT being a significant contributor. Therefore, further adjustments to both the policy and transplant practices should be considered to further optimize equity and outcomes.
2021年3月实施了新的已故捐赠者肾脏分配系统(KAS250),优先考虑距离捐赠医院250海里半径范围内的接受者。实施KAS250是为了减少获得肾移植的地域差异。研究表明,实施KAS250后冷缺血时间(CIT)增加,但对移植物结局的影响尚不清楚。利用移植受者科学登记处的数据,我们估计了KAS250后(2021年4月至2022年12月)期间KAS250导致的1年死亡审查移植损失(DCGL)和全因移植损失(ACGL)的病因特异性风险;N=28,584),与kas250之前的时期(2017年1月至2018年12月;N = 23798)。我们发现kas250后的DCGL较高(风险比1.14;95% ci 1.02-1.26;p=0.0187)和ACGL(风险比1.22;95% CI 1.13-1.31, p< 0.0001)。中介分析显示,CIT间接介导了KAS250政策对DCGL和ACGL的影响,分别为45.54%和15.73%。总之,kas250后时代的短期移植物预后不如kas250前时代,恶化的CIT是一个重要因素。因此,应考虑进一步调整政策和移植实践,以进一步优化公平性和结果。
期刊介绍:
The American Journal of Transplantation is a leading journal in the field of transplantation. It serves as a forum for debate and reassessment, an agent of change, and a major platform for promoting understanding, improving results, and advancing science. Published monthly, it provides an essential resource for researchers and clinicians worldwide.
The journal publishes original articles, case reports, invited reviews, letters to the editor, critical reviews, news features, consensus documents, and guidelines over 12 issues a year. It covers all major subject areas in transplantation, including thoracic (heart, lung), abdominal (kidney, liver, pancreas, islets), tissue and stem cell transplantation, organ and tissue donation and preservation, tissue injury, repair, inflammation, and aging, histocompatibility, drugs and pharmacology, graft survival, and prevention of graft dysfunction and failure. It also explores ethical and social issues in the field.