Leeaphorn Napat, Sampaio Marcelo S, Natal Naowanit, Mehrnia Alireza, Kamgar Mandana, Huang Edmund, Kalantar-Zadeh Kamyar, Kaplan Bruce, Bunnapradist Suphamai
Clin Transpl. 2014:117-24.
In 2003, the United Network for Organ Sharing (UNOS) changed its policy to allow candidates with 'inactive' status to accrue time on the waitlist. In this study, we assessed the transplant outcomes among deceased donor kidney transplant (DDKT) recipients who were temporarily inactive specifically due to medical reason, i.e., being temporarily too sick (reason 7).
Using the UNOS database, adult DDKT recipients were divided into two groups: those who had never been inactivated (active group) and those with a history of being inactive due to reason 7 (reason 7 group). Patient and graft survival, 3-year risk of death, and graft failure were examined and compared.
After 3 years of follow-up, patient survival in the reason 7 group was significantly lower than that of the active group (88.14% versus 91.93%, p < 0.01). The reason 7 group had a 20% increased risk of death (hazard ratio, HR 1.20, confidence interval, CI 1.04 - 1.38), a 16% increase in graft failure (HR 1.16, CI 1.06-1.28), and a 15% decrease in death-censored graft failure (HR 1.15, CI 1.01-1.31).
Recipients with a history of reason 7 have lower patient and graft survival when compared to the active group. Nonetheless, the margins of difference are minimal. Candidates with a history of reason 7 should not be discouraged from transplantation once they return to active status. Standardized criteria for placing candidates on inactive status should be developed to reduce disparities among transplant centers.
2003年，器官共享联合网络（UNOS）改变了其政策，允许处于“非活跃”状态的候选人在等待名单上累计时间。在本研究中，我们评估了因医疗原因（即暂时病情过重，原因7）而暂时处于非活跃状态的已故供体肾移植（DDKT）受者的移植结局。
利用UNOS数据库，将成年DDKT受者分为两组：从未处于非活跃状态的受者（活跃组）和因原因7有非活跃状态病史的受者（原因7组）。对患者和移植物存活率、3年死亡风险和移植物失败情况进行检查和比较。
经过3年的随访，原因7组的患者存活率显著低于活跃组（88.14%对91.93%，p<0.01）。原因7组的死亡风险增加20%（风险比，HR 1.20，置信区间，CI 1.04 - 1.38），移植物失败风险增加16%（HR 1.16，CI 1.06 - 1.28），死亡审查后的移植物失败风险降低15%（HR 1.15，CI 1.01 - 1.31）。
与活跃组相比，有原因7病史的受者的患者和移植物存活率较低。尽管如此，差异幅度很小。有原因7病史的候选人一旦恢复活跃状态，不应被劝阻进行移植。应制定将候选人置于非活跃状态的标准化标准，以减少移植中心之间的差异。
