高肾源评分指数供肾者-受者匹配以优化供肾利用。
Donor-Recipient Matching to Optimize the Utility of High Kidney Donor Profile Index Kidneys.
机构信息
Hartford Hospital Transplant and Comprehensive Liver Center, Hartford, Connecticut.
Department of Surgery, University of Minnesota, Minneapolis, Minnesota.
出版信息
Transplant Proc. 2021 Apr;53(3):865-871. doi: 10.1016/j.transproceed.2020.10.040. Epub 2020 Dec 25.
BACKGROUND
In December 2014, the Kidney Donor Profile Index (KDPI) was developed to give more precise information on donor kidney quality. Kidneys with KDPI scores ≥ 85 (K ≥ 85) have been reported to have inferior outcomes to kidneys with KDPI scores < 85.
METHODS
After the implementation of the new Kidney Allocation System, we developed a protocol to evaluate K ≥ 85 use. We analyzed the safety and efficacy of our institutional criteria and evaluated post-transplant outcomes. K ≥ 85 recipients were stratified based on their 1-year creatinine and estimated glomerular filtration rates to elucidate characteristics associated with serum creatinine < 1.7 mg/dL or estimated glomerular filtration rates ≤ 45 mL/min/1.73 m.
RESULTS
From December 2014 to December 2019, 304 deceased donor kidney transplants were performed at Hartford Hospital; 58 (19%) were K ≥ 85 with an average KDPI of 91%. There were 4 graft losses; 2 were death censored. Prolonged cold ischemia time and black recipient race were associated with inferior recipient graft function at 1 year.
CONCLUSIONS
High KDPI kidney use requires a multifaceted evaluation that takes into account donor and recipient characteristics for an ideal match. We have identified several characteristics that may predict optimal post-transplant kidney function.
背景
2014 年 12 月，开发了肾脏供者特征指数（KDPI），以提供更精确的供肾质量信息。KDPI 评分≥85（K≥85）的肾脏被报道其预后劣于 KDPI 评分<85 的肾脏。
方法
在新的肾脏分配系统实施后，我们制定了一项评估 K≥85 使用的方案。我们分析了机构标准的安全性和有效性，并评估了移植后的结果。根据 1 年肌酐和估算肾小球滤过率，将 K≥85 受者分层，以阐明与血清肌酐<1.7mg/dL 或估算肾小球滤过率≤45mL/min/1.73m 相关的特征。
结果
2014 年 12 月至 2019 年 12 月，哈特福德医院共进行了 304 例死亡供体肾移植，其中 58 例（19%）为 K≥85，平均 KDPI 为 91%。有 4 例移植物丢失，其中 2 例为死亡。较长的冷缺血时间和黑人受者种族与 1 年时受者移植物功能较差相关。
结论
高 KDPI 肾脏的使用需要进行多方面的评估，需要考虑供体和受者的特征，以达到理想的匹配。我们已经确定了一些可能预测最佳移植后肾功能的特征。
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