Schold J D, Srinivas T R, Kayler L K, Meier-Kriesche H U
Department of Medicine, and Department of Health Services Research, Management and Policy, University of Florida, Gainesville, FL, USA.
Am J Transplant. 2008 Jan;8(1):58-68. doi: 10.1111/j.1600-6143.2007.02020.x. Epub 2007 Nov 2.
The survival advantage of kidney transplantation extends to many high-risk ESRD patients; however, numerous factors ultimately determine which patients are evaluated and listed for the procedure. Broad goals of patient evaluation comprise identifying patients who will benefit from transplantation and excluding patients who might be placed at risk. There is limited data detailing whether current access limitations and screening strategies have achieved the goal of listing the most appropriate patients. The study estimated the life expectancy of adult patients in the United States prior to transplantation with ESRD onset from 1995 to 2003. Factors associated with transplant listing were examined based on patient prognosis after ESRD. Approximately one-third of patients listed for transplantation within 1 year of ESRD had </=5-year life expectancy on dialysis. In contrast, one-third of patients not listed had >5-year life expectancy. The number of patients not listed with 'good' prognosis was significantly higher than those listed with 'poor' prognosis (134 382 vs. 16 807, respectively). Age, race, gender, insurance coverage and body mass index (BMI) were associated with likelihood for listing with 'poor' prognosis and not listing with 'good' prognosis. Over the past decade, many ESRD patients viable for transplantation have not listed for transplantation while higher-risk patients have listed rapidly.
肾移植的生存优势惠及许多高危终末期肾病（ESRD）患者；然而，诸多因素最终决定了哪些患者会接受评估并被列入移植名单。患者评估的总体目标包括识别出能从移植中获益的患者，并排除可能面临风险的患者。关于当前获取途径限制和筛查策略是否实现了将最合适患者列入名单这一目标的数据有限。该研究估算了1995年至2003年美国成年ESRD患者在移植前的预期寿命。基于ESRD后的患者预后情况，对与列入移植名单相关的因素进行了研究。在ESRD发病后1年内被列入移植名单的患者中，约三分之一在透析时的预期寿命≤5年。相比之下，未被列入名单的患者中有三分之一的预期寿命>5年。预后“良好”但未被列入名单的患者数量显著高于预后“较差”而被列入名单的患者（分别为134382例和16807例）。年龄、种族、性别、保险覆盖范围和体重指数（BMI）与预后“较差”被列入名单以及预后“良好未被列入名单的可能性相关。在过去十年中，许多适合移植的ESRD患者未被列入移植名单，而高危患者迅速被列入名单。
