Center for Surgery and Public Health at Brigham and Women's Hospital, Boston, MA, USA.
Department of Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Clin Transplant. 2021 May;35(5):e14250. doi: 10.1111/ctr.14250. Epub 2021 Feb 27.
While kidney transplantation is optimal for the treatment of end-stage kidney disease, available organs do not meet demand. Little is known about the outcomes of patients who are delisted (removed from the waitlist) and unable to benefit from transplant. We describe patients who are delisted and their life expectancy after delisting.
Patients ≥ 18 years listed for deceased donor kidney transplant between 01/2003 and 12/2013 were identified in the Scientific Registry of Transplant Recipients and followed through 12/2018. A competing risk model was used to measure the association of demographic and clinical factors with waitlist outcomes of delisting, transplant, and death. Multivariate Cox modeling was used to evaluate factors associated with death after delisting.
Of 324,582 patients listed, 18.0% were delisted, most common reasons were "too sick" or "other." After delisting, half (49.7%) had died by end of follow-up; time to death after removal was 5 years. Increasing age and public insurance were associated with increased risk of death.
Nearly one in five patients will be delisted from the kidney transplant waitlist. These patients live a surprisingly long time after removal. Much remains unknown about these patients, which could be improved through data collection. Delisting is an important patient outcome that warrants further exploration.
虽然肾移植是治疗终末期肾病的最佳方法，但可获得的器官无法满足需求。对于那些被取消（从等待名单中删除）且无法受益于移植的患者的结果知之甚少。我们描述了被取消资格的患者及其取消资格后的预期寿命。
在 2003 年 1 月至 2013 年 12 月期间，在 Scientific Registry of Transplant Recipients 中确定了≥18 岁的已故供体肾移植等待名单上的患者，并随访至 2018 年 12 月。使用竞争风险模型来衡量人口统计学和临床因素与等待名单上的取消资格、移植和死亡的结果之间的关联。使用多变量 Cox 模型评估与取消资格后死亡相关的因素。
在列出的 324582 名患者中，有 18.0%被取消资格，最常见的原因是“病得太重”或“其他”。取消资格后，有一半（49.7%）在随访结束时已经死亡；从移除到死亡的时间为 5 年。年龄增长和公共保险与死亡风险增加相关。
近五分之一的患者将被从肾移植等待名单中取消资格。这些患者在被移除后还能活很长时间。对于这些患者，我们知之甚少，通过数据收集可以对此进行改进。取消资格是一个重要的患者结果，值得进一步探讨。
