Gentry S E, Segev D L, Simmerling M, Montgomery R A
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD.
Am J Transplant. 2007 Oct;7(10):2361-70. doi: 10.1111/j.1600-6143.2007.01935.x.
In kidney paired donation (KPD), incompatible pairs exchange kidneys so that each recipient receives a compatible organ. This modality is underutilized partly because of the difficulty of finding a suitable match among incompatible pairs. Alternatively, recipients with compatible donors might enter KPD arrangements in order to be matched with a donor predicted to give greater allograft durability or for other altruistic reasons. Using simulated donors and recipients, we investigated the impact of allowing recipients and their compatible donors to participate in KPD. For KPD programs of any size, the participation of compatible donor/recipient pairs nearly doubled the match rate for incompatible pairs (28.2% to 64.5% for single-center program, 37.4% to 75.4% for national program). Legal, logistical, and governmental controversies have hampered the expansion of KPD in the United States by delaying the creation of a national program. The inclusion of compatible pairs into small single-center pools could achieve match rates that would surpass that which could be realized by a national list made up of only incompatible pairs. This new paradigm of KPD can immediately be instituted at the single-center level, while the greatest gains will be achieved by incorporating compatible pairs into a national program.
在肾成对捐赠（KPD）中，不相容的配对交换肾脏，以便每个受者都能获得一个相容的器官。这种方式未得到充分利用，部分原因是在不相容的配对中难以找到合适的匹配。另外，有相容供者的受者可能会参与KPD安排，以便与预计能提供更持久同种异体移植物的供者匹配，或出于其他利他原因。我们使用模拟的供者和受者，研究了允许受者及其相容供者参与KPD的影响。对于任何规模的KPD项目，相容供者/受者配对的参与几乎使不相容配对的匹配率翻倍（单中心项目从28.2%提高到64.5%，全国性项目从37.4%提高到75.4%）。法律、后勤和政府方面的争议因推迟建立全国性项目而阻碍了KPD在美国的扩展。将相容配对纳入小型单中心库可以实现的匹配率，将超过仅由不相容配对组成的全国名单所能实现的匹配率。这种KPD的新模式可以立即在单中心层面实施，而通过将相容配对纳入全国性项目将取得最大收益。
