Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Stanford, California.
Department of Surgery, Stanford University School of Medicine, Stanford, California.
Clin Transplant. 2018 Nov;32(11):e13406. doi: 10.1111/ctr.13406. Epub 2018 Oct 15.
Kidney transplant wait-list management is becoming increasingly complex. We introduced a novel wait-list management strategy at our center, the Transplant Readiness Assessment Clinic (TRAC), whereby patients whose Kidney Allocation Scores surpass a threshold are actively managed. From January 1, 2016 through June 30, 2017, we evaluated 195 patients through TRAC. Compared to pre-TRAC systems at our institution, TRAC resulted in a higher proportion of activation at 18 months (38% vs 22%-26%, P < 0.0001), despite being enriched in patients with long dialysis duration. TRAC also resulted in a higher proportion of wait-list removal (15% vs 8%-9%, P < 0.05) although combined wait-list removal and death on wait-list did not differ (18% vs 16%-17%). Median time to activation was 356 days from TRAC evaluation. Of the transplant barriers, need for cardiovascular studies was the most common (31%), followed by other medical issues (23%), poor functional status (13%), and psychosocial issues (10%). By concentrating center resources on patients most likely to be transplanted after activation and performing active patient management close to the time of transplant, TRAC has the potential to significantly enhance kidney transplant success in regions with long wait-times.
肾脏移植候补名单的管理正变得日益复杂。我们在本中心引入了一种新的候补名单管理策略，即移植准备评估门诊（TRAC），对分配分数超过一定阈值的患者进行积极管理。从 2016 年 1 月 1 日至 2017 年 6 月 30 日，我们通过 TRAC 对 195 名患者进行了评估。与本机构的 TRAC 前系统相比，尽管 TRAC 中患者的透析时间较长，但在 18 个月时的激活比例更高（38%比 22%-26%，P<0.0001）。TRAC 还导致更高的候补名单删除比例（15%比 8%-9%，P<0.05），尽管候补名单删除和候补名单上的死亡的总和没有差异（18%比 16%-17%）。从 TRAC 评估到激活的中位时间为 356 天。在移植障碍中，心血管研究的需求最为常见（31%），其次是其他医疗问题（23%）、功能状态差（13%）和心理社会问题（10%）。通过集中中心资源用于最有可能在激活后进行移植的患者，并在接近移植时间时对患者进行积极管理，TRAC 有可能显著提高在等待时间较长的地区的肾脏移植成功率。
