Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland 21205, USA.
Curr Opin Organ Transplant. 2011 Aug;16(4):404-9. doi: 10.1097/MOT.0b013e3283489910.
A major policy change affecting renal organ allocation to sensitized patients in the US was implemented in October, 2009. Extra allocation points are awarded to sensitized patients based on a calculated panel reactive antibody (CPRA). This review will discuss the reasons underlying this policy change and examine the evidence to date of its impact on renal allocation.
Comparison of both the proportion and transplant rates of sensitized renal transplant candidates during the 6 months prior to the policy implementation and 6 months after implementation showed a significant increase in transplantation of sensitized patients, with the greatest difference occurring among broadly sensitized patients with CPRA values of 80 or greater. Whereas there was a decrease in transplant rates among candidates with CPRA values from 1 to 20, both this decrease and the increased rates among the more highly sensitized recipients were proportional to the distributions of these groups on the wait list. Notably, following the policy change, there was a highly significant decrease in organ refusals due to positive cross-matches with an 83% reduction between the 6-month periods prior to and after the policy implementation. Additional analyses have recently shown the continuation of these trends 1 year after the policy implementation.
Implementation of the CPRA policy on national renal organ allocation in the US has increased efficiency in organ allocation and is helping to facilitate transplantation of broadly sensitized candidates.
美国于 2009 年 10 月实施了一项重大政策变更，影响了致敏患者的肾脏器官分配。根据计算出的群体反应性抗体（CPRA），为致敏患者额外分配配体。本文将讨论这一政策变化的原因，并探讨迄今为止其对肾脏分配影响的证据。
在政策实施前 6 个月和实施后 6 个月比较致敏肾移植候选者的比例和移植率，发现致敏患者的移植显著增加，其中 CPRA 值为 80 或更高的广泛致敏患者的差异最大。而 CPRA 值为 1 至 20 的候选者的移植率下降，这一下降以及更高度致敏受者的增加率与这些群体在候补名单上的分布成正比。值得注意的是，政策变更后，由于交叉配型阳性导致器官拒绝的情况显著减少，与政策实施前 6 个月相比减少了 83%。最近的其他分析显示，这些趋势在政策实施 1 年后仍在继续。
美国在全国肾脏器官分配中实施 CPRA 政策提高了器官分配的效率，并有助于促进广泛致敏候选者的移植。
