Torlak F, Ayvaci M U S, Ahsen M E, Arce C, Vazquez M A, Tanriover B
Neurobiology Department, University of Texas at Dallas, Dallas, Texas, USA.
Information Systems and Operations Management, University of Texas at Dallas, Dallas, Texas, USA.
Transplant Proc. 2016 Jul-Aug;48(6):1916-9. doi: 10.1016/j.transproceed.2016.03.041.
On December 4, 2014, a new deceased donor kidney allocation system (KAS) was implemented. The KAS was designed to improve organ equity and graft-recipient longevity matching. However, estimated wait-time to deceased donor transplantation is difficult to predict post-KAS.
Using the Kidney-Pancreas Simulated Allocation Model software (KPSAM), a program that the Organ Procurement and Transplant Network uses to assess policy proposals, we compared the kidney allocations of both the new (post-KAS) and old policies (pre-KAS) (10 iterations for each group; total N = 204,148) and estimated wait-time based on blood type, duration of dialysis exposure, and calculated panel-reactive antibody (CPRA).
The simulations revealed that estimated median (25(th) and 75(th) percentile) waiting time in transplanted recipients decreased from 2.3 (1.2, 3.8) years in the old allocation to 1.8 (0.8, 3.4) years in the new allocation system. The rate of transplantations performed within the first year of wait-listing increased from 20.7% to 31.3%. The KPSAM resulted in more transplantations in recipients with more than 5 years of dialysis exposure (26.5% to 37.4%), longevity matching (12.2% to 17.5%), blood group B (12.6% to 17.2%), and high CPRA ≥98% (1.9% to 4.3%) in post-KAS compared with pre-KAS simulations.
Based on the KPSAM results, it was projected that post-KAS wait-time in transplanted recipients might decrease approximately 6 months (22%) across all CPRA categories. It might be related to the KAS awarding waiting time points for prelisting dialysis time and priority points awarded based on CPRA (bolus effect).
2014年12月4日，一种新的已故捐赠者肾脏分配系统（KAS）开始实施。该系统旨在提高器官分配的公平性，并使移植受者与移植器官的寿命更匹配。然而，在KAS实施后，预测已故捐赠者移植的估计等待时间变得困难。
我们使用肾脏-胰腺模拟分配模型软件（KPSAM）（器官获取与移植网络用于评估政策提案的程序），比较了新政策（KAS实施后）和旧政策（KAS实施前）的肾脏分配情况（每组10次迭代；总样本量N = 204,148），并根据血型、透析时间和计算得出的群体反应性抗体（CPRA）来估计等待时间。
模拟结果显示，移植受者的估计中位等待时间（第25和第75百分位数）从旧分配系统中的2.3（1.2，3.8）年降至新分配系统中的1.8（0.8，3.4）年。在等待名单的第一年内进行移植的比例从20.7%增至31.3%。与KAS实施前的模拟相比（KPSAM），在KAS实施后的模拟中，透析时间超过5年的受者、寿命匹配、B血型以及CPRA≥98%的高群体反应性抗体受者的移植比例更高（分别为从26.5%至37.4%、12.2%至17.5%、12.6%至17.2%、1.9%至4.3%）。
根据KPSAM的结果预测，在所有CPRA类别中，KAS实施后移植受者的等待时间可能会减少约6个月（22%）。这可能与KAS为透析前时间授予等待时间点以及根据CPRA授予优先点有关（推注效应）。
