Decoteau Mary A, Stewart Darren E, Toll Alice E, Kurian Sunil M, Case Jamie, Marsh Christopher L
Scripps Center for Organ and Cell Transplantation, Scripps Clinic and Scripps Green Hospital, La Jolla, CA, USA; Department of General Surgery, Naval Medical Center San Diego, San Diego, CA, USA.
United Network for Organ Sharing, Richmond, VA, USA.
Transplant Proc. 2021 Mar;53(2):569-580. doi: 10.1016/j.transproceed.2020.10.036. Epub 2021 Feb 3.
Transplant candidates can be listed at multiple transplant centers to increase the probability of receiving an organ. We evaluated the association between multilisting (ML) status and access to a deceased donor kidney transplant (DDKT) to determine if ML provides a long-term advantage regarding wait-list mortality and recipient outcomes.
Candidates between January 2010 and October 2017 were identified as either singly or multiply listed using Organ Procurement and Transplantation Network data and cohorts before and after implementation of the Kidney Allocation System (KAS). Cross-sectional logistic regression was used to assess relationships between candidate factors and ML prevalence (5.4%).
Factors associated with ML pre-KAS included having blood type B (reference, type O; odds ratio [OR], 1.20; P < .001), having private insurance (OR, 1.5; P < .001), wait time (OR, 1.28; P < .001), and increasing calculated panel-reactive antibody (cPRA) (reference, cPRA 0-100; OR for cPRA 80-98, 2.83; OR for cPRA 99, 3.47; OR for cPRA 100, 5.18; P < .001). Transplant rates were double for multilisted vs singly listed recipients (adjusted hazard ratio [aHR], 2.16; P < .001). Extra-donor service area ML candidates received transplants 2.5 years quicker than single-listing (SL) candidates, conferring a 42% wait-list advantage. Recipient death (aHR, 0.94; P = .122) and graft failure (aHR, 0.91; P = .006) rates were also lower for ML recipients.
In the KAS era, ML continues to increase the likelihood of receiving a DDKT and lower the incidence of wait-list mortality, and it confers a survival advantages over SL.
移植候选者可在多个移植中心登记，以提高获得器官的概率。我们评估了多中心登记（ML）状态与接受 deceased donor kidney transplant（DDKT）之间的关联，以确定 ML 在等待名单死亡率和受者结局方面是否具有长期优势。
利用器官获取与移植网络数据以及肾脏分配系统（KAS）实施前后的队列，将 2010 年 1 月至 2017 年 10 月期间的候选者确定为单中心登记或多中心登记。采用横断面逻辑回归分析来评估候选者因素与 ML 患病率（5.4%）之间的关系。
KAS 实施前与 ML 相关的因素包括血型为 B（参照组为血型 O；比值比[OR]，1.20；P <.001）、拥有私人保险（OR，1.5；P <.001）、等待时间（OR，1.28；P <.001）以及计算得出的群体反应性抗体（cPRA）升高（参照组为 cPRA 0 - 100；cPRA 80 - 98 的 OR 为 2.83；cPRA 99 的 OR 为 3.47；cPRA 100 的 OR 为 5.18；P <.001）。多中心登记受者的移植率是单中心登记受者的两倍（调整后风险比[aHR]，2.16；P <.001）。额外供体服务区的 ML 候选者比单中心登记（SL）候选者提前 2.5 年接受移植，在等待名单上具有 42%的优势。ML 受者的受者死亡（aHR，0.94；P =.122）和移植物失败（aHR，0.91；P =.006）率也较低。
在 KAS 时代，ML 继续增加接受 DDKT 的可能性并降低等待名单死亡率，并且与 SL 相比具有生存优势。
