Ramanathan Rajesh, Gupta Gaurav, Kim Joohyun, Quinn Keri, Behnke Martha, Kang Le, Sharma Amit
Hume-Lee Transplant Center, Virginia Commonwealth University, Richmond, VA, USA.
Department of Biostatistics, Virginia Commonwealth University, Richmond, VA, USA.
Clin Transplant. 2015 Dec;29(12):1148-55. doi: 10.1111/ctr.12642. Epub 2015 Nov 3.
The kidney allocation system (KAS) aims to improve deceased donor kidney transplant outcomes by matching of donor allografts and kidney recipients using the kidney donor risk index (KDRI) and recipient estimated post-transplant survival (EPTS) indices. In this single-center study, KAS was retroactively applied to 573 adult deceased donor kidney transplants (2004-2012) performed in the extended criteria/standard criteria donor (ECD/SCD) era. Donor KDRI and recipient EPTS were calculated, and transplants were analyzed to identify KAS fits. These were defined as allocation of top 20% allografts to top 20% recipients and bottom 80% allografts to bottom 80% recipients. On retroactive calculation, 70.2% of all transplants fit the KAS. Transplants that fit the KAS had inferior 1- and 5-yr patient survival (95.5% vs. 98.8%, p = 0.048, and 83.4% vs. 91.7%, p = 0.018) and similar 1- and 5-yr graft survival compared to transplants that did not fit the KAS (91.3% vs. 94.1%, p = 0.276, and 72.7% vs. 73.9%, p = 0.561). While EPTS correlated with recipient survival (HR = 2.96, p < 0.001), KDRI correlated with both recipient (HR = 3.56, p < 0.001) and graft survival (HR = 3.23, p < 0.001). Overall, retroactive application of the KAS to transplants performed in the ECD/SCD era did not identify superior patient survival for kidneys allocated in accordance with the KAS.
肾脏分配系统（KAS）旨在通过使用肾脏供体风险指数（KDRI）和受体移植后估计生存率（EPTS）指数来匹配供体同种异体移植物和肾脏受体，从而改善已故供体肾脏移植的结果。在这项单中心研究中，KAS被追溯应用于在扩大标准/标准标准供体（ECD/SCD）时代进行的573例成人已故供体肾脏移植（2004 - 2012年）。计算供体KDRI和受体EPTS，并对移植进行分析以确定KAS匹配情况。这些被定义为将前20%的同种异体移植物分配给前20%的受体，后80%的同种异体移植物分配给后80%的受体。经追溯计算，所有移植中有70.2%符合KAS。与不符合KAS的移植相比，符合KAS的移植患者1年和5年生存率较低（95.5%对98.8%，p = 0.048，以及83.4%对91.7%，p = 0.018），而1年和5年移植物生存率相似（91.3%对94.1%，p = 0.276，以及72.7%对73.9%，p = 0.561）。虽然EPTS与受体生存率相关（HR = 2.96，p < 0.001），但KDRI与受体（HR = 3.56，p < 0.001）和移植物生存率均相关（HR = 3.23，p < 0.001）。总体而言，将KAS追溯应用于ECD/SCD时代进行的移植，并未发现按照KAS分配的肾脏具有更高的患者生存率。
