Schold J D, Howard R J, Scicchitano M J, Meier-Kriesche H-U
Department of Medicine, University of Florida, Gainesville, Florida, USA.
Am J Transplant. 2006 Jul;6(7):1689-95. doi: 10.1111/j.1600-6143.2006.01390.x.
The expanded criteria donor (ECD) policy was formalized in 2002, which defined higher-risk deceased donor kidneys recovered for transplantation. There has not been a comprehensive examination of the impact of policy on the allocation of ECD kidneys, waiting times for transplant, center listing patterns or human leukocyte antigen (HLA) matching. We examined transplant candidates from 1998 to 2004 utilizing a national database. We constructed models to assess alterations in recipient characteristics of ECD kidneys and trends in waiting time and cold ischemia time (CIT) associated with policy. We also evaluated the impact of the proportion of center candidate listings for ECD kidneys on waiting times. Elderly recipients were more likely to receive ECDs following policy (odds ratio = 1.36, p < 0.01). There was no association of decreased CIT or pretransplant dialysis time while increasing HLA mismatching with policy inception. Over one quarter of centers listed < 20% of candidates for ECDs, while an additional quarter of centers listed > 90%. Only centers with selective listing for ECDs offered reduced waiting times to ECD recipients. The ECD policy demonstrates potential to achieve certain ascribed goals; however, the full impact of the program, reaching all transplant candidates, may only be achieved once ECD listing patterns are recommended and adopted accordingly.
扩大标准供体（ECD）政策于2002年正式确立，该政策定义了用于移植的高风险死亡供体肾脏。目前尚未对该政策对ECD肾脏分配、移植等待时间、中心列名模式或人类白细胞抗原（HLA）配型的影响进行全面审查。我们利用一个全国性数据库对1998年至2004年的移植候选人进行了研究。我们构建了模型，以评估ECD肾脏受者特征的变化以及与该政策相关的等待时间和冷缺血时间（CIT）趋势。我们还评估了中心对ECD肾脏候选人列名比例对等待时间的影响。政策实施后，老年受者更有可能接受ECD肾脏（优势比=1.36，p<0.01）。随着政策实施，CIT或移植前透析时间的减少与HLA错配增加之间没有关联。超过四分之一的中心列出的ECD候选人不到20%，而另外四分之一的中心列出的候选人超过90%。只有对ECD进行选择性列名的中心为ECD受者提供了缩短的等待时间。ECD政策显示出实现某些既定目标的潜力；然而，该项目对所有移植候选人的全面影响，只有在相应地推荐并采用ECD列名模式后才能实现。
