Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN; Department of Surgery, University of Minnesota, Minneapolis, MN.
Am J Transplant. 2015 Jan;15 Suppl 2:1-34. doi: 10.1111/ajt.13195.
A new kidney allocation system, expected to be implemented in late 2014, will characterize donors on a percent scale (0%-100%) using the kidney donor profile index (KDPI). The 20% of deceased donor kidneys with the greatest expected posttransplant longevity will be allocated first to the 20% of candidates with the best expected posttransplant survival; kidneys that are not accepted will then be offered to remaining 80% of candidates. Waiting time will start at the time of maintenance dialysis initiation (even if before listing) or at the time of listing with an estimated glomerular filtration rate of 20 mL/min/1.73 m(2) or less. Under the current system, the number of candidates on the waiting list continues to increase, as each year more candidates are added than are removed. Median waiting times for adults increased from 3 years in 2003 to more than 4.5 years in 2009. Donation rates have not increased. Short-term outcomes continue to improve; death-censored graft survival at 90 days posttransplant was 97% or higher for deceased donor transplants and over 99% for living donor transplants. In 2013, 883 pediatric candidates were added to the waiting list; 65.8% of pediatric candidates on the list in 2013 underwent deceased donor transplant. Five-year graft survival was highest for living donor recipients aged younger than 11 years (89%) and lowest for deceased donor recipients aged 11 to 17 years (68%).
预计于 2014 年末实施的新肾脏分配系统将使用肾脏捐赠者概况指数（KDPI）对供体进行百分制特征描述（0%-100%）。将 20%具有最大预期移植后寿命的已故供体肾脏首先分配给具有最佳预期移植后生存的 20%候选人；未被接受的肾脏将随后提供给其余 80%的候选人。等待时间将从开始维持性透析（即使在列名之前）或在肾小球滤过率估计为 20 mL/min/1.73 m(2)或更低时开始列名。在现行系统下，随着每年新增候选人多于除名候选人，候补名单上的候选人数量持续增加。成年人的中位等待时间从 2003 年的 3 年增加到 2009 年的超过 4.5 年。捐赠率没有增加。短期结果继续改善；死亡病例被排除的移植后 90 天移植物存活率对于已故供体移植为 97%或更高，对于活体供体移植为 99%以上。2013 年，有 883 名儿科候选者被添加到候补名单中；2013 年候补名单上的 65.8%的儿科候选者接受了已故供体移植。5 年移植物存活率最高的是年龄小于 11 岁的活体供体受者（89%），而年龄在 11 至 17 岁的已故供体受者最低（68%）。
