确定增加肾联合捐赠通量的机会。

Identifying Opportunities to Increase the Throughput of Kidney Paired Donation.

机构信息

1 Department of Management Science and Engineering, Stanford University, Stanford CA. 2 Department of Urology, UCLA, Los Angeles, CA. 3 Department of Urology, Northshore University Health System, Highland Park, IL. 4 Department of Surgery, Stanford University, Stanford, CA.

出版信息

Transplantation. 2015 Jul;99(7):1410-5. doi: 10.1097/TP.0000000000000527.

DOI:10.1097/TP.0000000000000527

PMID:25606799

Abstract

BACKGROUND

Although kidney paired donation (KPD) has led to thousands of transplants, the 2012 KPD Consensus Conference concluded that more could be done. Perceptions are that a large number of match offers never resulted in transplantations, and unfruitful matches have both financial and emotional costs.

METHODS

To describe, quantify, and analyze the unrealized match offers, we studied the matching process from registration to transplantation in the National Kidney Registry, a large KPD registry, over a 25-month period.

RESULTS

Of the 3,180 match offers, 454 were turned down. The most common reasons were the donor was not acceptable (50%) and their recipient had unacceptably high donor-specific antibodies (28%). Of the 2,228 accepted offers, 1,335 advanced to the cell-based cross-match stage because 893 of these were part of chains that fell through. Fifty-five of 887 recorded cell-based cross-matches were positive, 20 donors were unacceptable, and 22 recipients had unacceptably high donor-specific antibodies. Six hundred ninety transplantations were performed.

CONCLUSION

Despite the success of KPD, by analyzing the matching process, we identify several strategies to increase the number of KPD transplantations, including recruiting more participants, processing the match offers more quickly at the transplant center level, enhancing the donor preselection tools, improving communication between centers and the registries, and combining desensitization with KPD.

摘要

背景

尽管肾对体捐赠（KPD）已经导致了数千例移植，但 2012 年的 KPD 共识会议得出结论，还可以做更多的工作。人们认为，大量的匹配提议从未导致移植，而无果的匹配既带来了经济上的损失，也带来了情感上的损失。

方法

为了描述、量化和分析未实现的匹配提议，我们在国家肾脏登记处（一个大型 KPD 登记处）研究了从注册到移植的匹配过程，时间跨度为 25 个月。

结果

在 3180 次匹配提议中，有 454 次被拒绝。最常见的原因是供体不可接受（50%），而他们的受体的供体特异性抗体水平过高（28%）。在 2228 次接受的提议中，有 1335 次进入基于细胞的交叉匹配阶段，因为其中 893 次是链中失败的一部分。在 887 次记录的基于细胞的交叉匹配中，有 55 次为阳性，20 名供体不可接受，22 名受体的供体特异性抗体水平过高。进行了 690 次移植。