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提高扩大标准供者政策作为改善肾脏分配的干预措施:它实际上是一个“净零”模式吗?

Enhancing the expanded criteria donor policy as an intervention to improve kidney allocation: is it actually a 'net-zero' model?

机构信息

Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.

出版信息

Am J Transplant. 2010 Dec;10(12):2582-5. doi: 10.1111/j.1600-6143.2010.03320.x.

DOI:10.1111/j.1600-6143.2010.03320.x
PMID:21070607
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4277869/
Abstract

In the United States, relatively little progress has been made in recent years to improve the efficiency and effectiveness of deceased donor kidney allocation. Despite enactment of the Expanded Criteria Donor (ECD) Policy in 2002, known inequities and suboptimal utility of donated kidneys persist. In contrast with dialysis patients with shorter predicted life expectancies, those with longer predicted lifetimes can often improve their survival by waiting longer for a Standard Criteria Donor (SCD) kidney. Yet, a substantial fraction of these candidates accept ECD kidneys, often poorly HLA matched. Meanwhile, waitlist mortality continues to rise, particularly among older transplant candidates. Despite required consent processes for candidates to list for ECD kidneys, centers appear to interpret and implement ECD policy differently—some list candidates selectively while others list nearly their entire candidate pool. To ensure more efficient and effective implementation of ECD policy across centers, we advocate for (1) more oversight and guidance in directing patients to the ECD list who stand to benefit the most from receipt of an ECD kidney; and (2) enhanced transparency of center-level ECD consent and listing practices. More uniform implementation of ECD policy could improve efficiency and effectiveness of deceased donor kidney allocation without deleteriously impacting equity.

摘要

在美国,近年来在提高已故供体肾脏分配的效率和效果方面进展甚微。尽管 2002 年颁布了扩大标准供体(ECD)政策,但仍存在众所周知的不平等和捐赠肾脏利用不足的问题。与预测寿命较短的透析患者相比,预测寿命较长的患者通过等待更长时间获得标准标准供体(SCD)肾脏,通常可以提高其生存率。然而,这些候选人中有相当一部分接受了 ECD 肾脏,通常 HLA 匹配不佳。与此同时,候补名单上的死亡率继续上升,尤其是在年龄较大的移植候选人中。尽管候选人为 ECD 肾脏进行登记需要经过同意程序,但各中心似乎对 ECD 政策的解释和执行存在差异——有些中心有选择地登记候选人,而有些中心则几乎将其全部候选人群登记。为确保 ECD 政策在各中心更有效地实施,我们主张(1)在指导最有可能从 ECD 肾脏中受益的患者登记 ECD 名单方面进行更多监督和指导;(2)增强中心层面 ECD 同意和登记做法的透明度。ECD 政策的更统一实施可以提高已故供体肾脏分配的效率和效果,而不会对公平性产生不利影响。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9662/4277869/8122e7417d55/nihms583878f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9662/4277869/8122e7417d55/nihms583878f1.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/9662/4277869/8122e7417d55/nihms583878f1.jpg

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本文引用的文献

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Am J Transplant. 2010 Apr;10(4):802-809. doi: 10.1111/j.1600-6143.2010.03020.x. Epub 2010 Feb 10.
2
Predictability of survival models for waiting list and transplant patients: calculating LYFT.等待名单患者和移植患者生存模型的可预测性:计算LYFT
Am J Transplant. 2009 Jul;9(7):1523-7. doi: 10.1111/j.1600-6143.2009.02708.x.
3
A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index.deceased donor kidneys 供体已死亡的肾脏,即供体肾脏来自已死亡的供体,而非活体供体。在医学领域,供体肾脏的获取对于肾脏移植手术至关重要,而 deceased donor kidneys 是常见的肾脏来源之一。与之相对的是 living donor kidneys,即活体供体的肾脏。 deceased donor kidneys 可以为众多终末期肾病患者带来肾脏移植的希望,提高他们的生活质量,延长生存期。然而,使用 deceased donor kidneys 进行移植也面临一些挑战和风险评估。例如,需要对供体的身体状况、病史等进行全面评估,以确保移植肾脏的质量和安全性。同时,对于受体而言,术后也需要密切监测和免疫抑制治疗,以防止排斥反应等并发症的发生。 在临床实践中,医生会综合考虑各种因素,权衡 deceased donor kidneys 的利弊,为患者制定最适合的治疗方案。 以下是根据你提供的英文内容“A comprehensive risk quantification score for deceased donor kidneys: the kidney donor risk index.”的译文: deceased donor kidneys 供体已死亡的肾脏,即供体肾脏来自已死亡的供体,而非活体供体。在医学领域,供体肾脏的获取对于肾脏移植手术至关重要,而 deceased donor kidneys 是常见的肾脏来源之一。与之相对的是 living donor kidneys,即活体供体的肾脏。 deceased donor kidneys 可以为众多终末期肾病患者带来肾脏移植的希望,提高他们的生活质量,延长生存期。然而,使用 deceased donor kidneys 进行移植也面临一些挑战和风险评估。例如,需要对供体的身体状况、病史等进行全面评估,以确保移植肾脏的质量和安全性。同时,对于受体而言,术后也需要密切监测和免疫抑制治疗,以防止排斥反应等并发症的发生。 在临床实践中,医生会综合考虑各种因素,权衡 deceased donor kidneys 的利弊,为患者制定最适合的治疗方案。 针对 deceased donor kidneys 的综合风险量化评分:肾脏供体风险指数
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A lifetime versus a graft life approach redefines the importance of HLA matching in kidney transplant patients.采用受者终身生存与移植物存活的方法重新定义了肾移植患者中HLA配型的重要性。
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Half of kidney transplant candidates who are older than 60 years now placed on the waiting list will die before receiving a deceased-donor transplant.目前被列入等待名单的60岁以上的肾移植候选者中,有一半会在接受尸体供体移植前死亡。
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