Sydney School of Public Heath, The University of Sydney, Camperdown, NSW, Australia.
Centre for Kidney Research, Kid's Research Institute, The Children's Hospital at Westmead.
Transplantation. 2018 Sep;102(9):1530-1537. doi: 10.1097/TP.0000000000002144.
To determine the incremental gains in graft and patient survival under a risk-based, deceased donor kidney allocation compared with the current Australian algorithm.
Risk-based matching algorithms were applied to first graft, kidney only recipients (n = 7513) transplanted in Australia between 1994 and 2013. Probabilistic models were used to compare the waiting time, life, and QALYs and graft years between the 8 risk-based allocation strategies against current practice.
Compared with current practice, Kidney Donor Risk Index-Estimated Posttransplant Survival matching of the lowest 20% of scores reduced median waiting time by 0.64 years (95% confidence interval [CI], 0.52-0.73) for recipients aged 30 years or younger, but increased waiting time by 0.94 years (95% CI, 0.79-1.09) for recipients older than 60 years. Among all age groups, the greatest gains occurred if Kidney Donor Risk Index-Estimated Posttransplant Survival matching of the lowest 30% of scores was used, incurring a median overall gain of 0.63 (95% CI, 0.03-1.25) life years and 0.78 (95% CI, 0.30-1.26) graft years compared with the current practice. A median gain in survival of 1.91 years for younger recipients (aged 30-45 years) was offset by a median reduction in survival (by 0.95 life years) among the older recipients. Prioritization of lower-quality donor kidneys for older candidates reduced the waiting time for recipients older than 45 years, but no changes in graft and patient survivals were observed.
Risk-based matching engendered a moderate, overall increase in graft and patient survivals, accrued through benefits for recipients 45 years or younger but disadvantage to recipients older than 60 years.
为了确定基于风险的已故供体肾脏分配方案相较于当前澳大利亚算法在移植物和患者存活率方面的额外获益。
将风险匹配算法应用于 1994 年至 2013 年间在澳大利亚接受首次移植的 7513 例仅接受肾脏移植的患者。使用概率模型来比较 8 种风险分配策略与现行实践之间的等待时间、寿命、QALYs 和移植物年数。
与现行实践相比,对于年龄在 30 岁或以下的受者,最低 20%分数的 Kidney Donor Risk Index-Estimated Posttransplant Survival 匹配可使中位等待时间减少 0.64 年(95%置信区间[CI],0.52-0.73),但对于年龄大于 60 岁的受者,等待时间增加 0.94 年(95%CI,0.79-1.09)。在所有年龄组中,如果使用最低 30%分数的 Kidney Donor Risk Index-Estimated Posttransplant Survival 匹配,则获益最大,与现行实践相比,总体中位寿命增加 0.63 年(95%CI,0.03-1.25),中位移植物年数增加 0.78 年(95%CI,0.30-1.26)。对于年龄在 30-45 岁的年轻受者,生存获益中位数增加 1.91 年,但年龄较大的受者生存获益中位数减少 0.95 年。对于年龄较大的候选者,优先考虑低质量供体肾脏会减少年龄大于 45 岁的受者的等待时间,但观察到移植物和患者存活率没有变化。
基于风险的匹配方案使移植物和患者存活率适度提高,这主要得益于 45 岁及以下受者获益,但不利于 60 岁及以上受者。