Division of Transplantation Surgery, Department of Surgery, University of Nebraska Medical Center, Omaha, NE, USA.
College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Pediatr Transplant. 2021 Mar;25(2):e13863. doi: 10.1111/petr.13863. Epub 2020 Oct 7.
Kidney transplant is the best treatment for end-stage renal disease (ESRD); however, access is limited by severe organ shortage. Public Health Service increased risk donors (PHS-IRD) represent a significant portion of available organs which are discarded at disproportional rates.
Pediatric nephrologists were surveyed regarding PHS-IRD kidneys to understand attitudes and perceived barriers to the use of these grafts in children. We sought to elucidate what methods may help increase the likelihood of PHS-IRD acceptance.
Twenty-two responses were received from United States pediatric nephrologists representing 11 UNOS regions (response rate 5.9%). Of respondents, 50% had been practicing for 20+ years, 77% in academic hospitals, and 63% in cities with over 1 000 000 people. All respondents worked in an institution with a kidney transplant program. 41% reported that they would not accept PHS-IRD kidneys under any circumstance, 45% would accept depending on the candidate's medical status, and 14% routinely accepted PHS-IRD kidneys. Infectious transmission was the biggest disincentive reported (59%), with only 55% of respondents feeling comfortable counseling families on the associated risks. 82% of respondents did not perceive all PHS-IRD as the same, and 90% supported stratifying PHS-IRD into tiers based on risk, which would increase the likelihood of organ acceptance (82%) and assist in counseling families (91%).
With improved utilization, PHS-IRD kidneys offer a step toward decreasing the organ shortage. These findings suggest hesitance in use of PHS-IRD kidneys for pediatric recipients. Further stratification of risk could aid in provider organ acceptance and counseling patients.
肾移植是治疗终末期肾病（ESRD）的最佳方法；然而，由于器官严重短缺，这种治疗方法的应用受到限制。公共卫生服务增加风险供体（PHS-IRD）代表了大量可利用的器官，这些器官被不成比例地丢弃。
调查了儿科肾病医生对 PHS-IRD 肾脏的态度和对在儿童中使用这些移植物的认知障碍，以了解如何增加 PHS-IRD 接受的可能性。
从代表 11 个 UNOS 区域的美国儿科肾病医生那里收到了 22 份答复（答复率为 5.9%）。受访者中，50%的人从业时间超过 20 年，77%在学术医院工作，63%在人口超过 100 万的城市工作。所有受访者都在有肾脏移植项目的机构工作。41%的人表示，他们在任何情况下都不会接受 PHS-IRD 肾脏，45%的人会根据候选人的医疗状况接受，14%的人则会定期接受 PHS-IRD 肾脏。传染病传播是报告中最大的障碍（59%），只有 55%的受访者对与相关风险咨询家庭感到满意。82%的受访者认为并非所有 PHS-IRD 都相同，90%的受访者支持根据风险将 PHS-IRD 分层，这将增加器官接受的可能性（82%）并有助于咨询家庭（91%）。
随着利用率的提高，PHS-IRD 肾脏为减少器官短缺提供了一种途径。这些发现表明，在儿科受者中使用 PHS-IRD 肾脏存在犹豫。进一步分层风险可以帮助提供者接受器官并咨询患者。
