Segev Dorry L, Gentry Sommer E, Warren Daniel S, Reeb Brigitte, Montgomery Robert A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
JAMA. 2005 Apr 20;293(15):1883-90. doi: 10.1001/jama.293.15.1883.
Blood type and crossmatch incompatibility will exclude at least one third of patients in need from receiving a live donor kidney transplant. Kidney paired donation (KPD) offers incompatible donor/recipient pairs the opportunity to match for compatible transplants. Despite its increasing popularity, very few transplants have resulted from KPD.
To determine the potential impact of improved matching schemes on the number and quality of transplants achievable with KPD.
DESIGN, SETTING, AND POPULATION: We developed a model that simulates pools of incompatible donor/recipient pairs. We designed a mathematically verifiable optimized matching algorithm and compared it with the scheme currently used in some centers and regions. Simulated patients from the general community with characteristics drawn from distributions describing end-stage renal disease patients eligible for renal transplantation and their willing and eligible live donors.
Number of kidneys matched, HLA mismatch of matched kidneys, and number of grafts surviving 5 years after transplantation.
A national optimized matching algorithm would result in more transplants (47.7% vs 42.0%, P<.001), better HLA concordance (3.0 vs 4.5 mismatched antigens; P<.001), more grafts surviving at 5 years (34.9% vs 28.7%; P<.001), and a reduction in the number of pairs required to travel (2.9% vs 18.4%; P<.001) when compared with an extension of the currently used first-accept scheme to a national level. Furthermore, highly sensitized patients would benefit 6-fold from a national optimized scheme (2.3% vs 14.1% successfully matched; P<.001). Even if only 7% of patients awaiting kidney transplantation participated in an optimized national KPD program, the health care system could save as much as $750 million.
The combination of a national KPD program and a mathematically optimized matching algorithm yields more matches with lower HLA disparity. Optimized matching affords patients the flexibility of customizing their matching priorities and the security of knowing that the greatest number of high-quality matches will be found and distributed equitably.
血型和交叉配型不相容将导致至少三分之一有需求的患者无法接受活体供肾移植。肾移植配对捐赠（KPD）为不相容的供体/受体对提供了匹配兼容移植的机会。尽管其越来越受欢迎，但通过KPD进行的移植却很少。
确定改进的匹配方案对通过KPD可实现的移植数量和质量的潜在影响。
设计、设置和人群：我们开发了一个模拟不相容供体/受体对库的模型。我们设计了一种数学上可验证的优化匹配算法，并将其与目前一些中心和地区使用的方案进行比较。模拟的患者来自普通人群，其特征取自描述符合肾移植条件的终末期肾病患者及其愿意且符合条件的活体供体的分布。
匹配的肾脏数量、匹配肾脏的HLA错配情况以及移植后5年存活的移植物数量。
与将目前使用的先接受方案扩展到全国范围相比，全国优化匹配算法将导致更多的移植（47.7%对42.0%，P<0.001）、更好的HLA一致性（错配抗原数为3.0对4.5；P<0.001）、5年时更多存活的移植物（34.9%对28.7%；P<0.001）以及需要出行的配对数量减少（2.9%对18.4%；P<0.001）。此外，高度致敏患者将从全国优化方案中受益6倍（成功匹配率为2.3%对14.1%；P<0.001）。即使只有7%等待肾移植的患者参与全国优化的KPD项目，医疗保健系统也可节省多达7.5亿美元。
全国KPD项目与数学优化匹配算法相结合可产生更多匹配且HLA差异更小。优化匹配为患者提供了定制匹配优先级的灵活性，以及知道将找到并公平分配最多数量的高质量匹配的安全感。
