Herbst Leyla R, Zeiser Laura Bowles, Mitchell Jonathan, Nijhar Kieranjeet, Perincherry Vijay, López Julia I, Segev Dorry L, Massie Allan B, King Elizabeth, Cameron Andrew M
From the Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD (Herbst, Zeiser, Mitchell, Nijhar, López, Segev, Massie, King, Cameron).
the Department of Surgery, Howard University Hospital, Washington, DC (Mitchell).
J Am Coll Surg. 2022 Apr 1;234(4):615-623. doi: 10.1097/XCS.0000000000000099.
Nondirected donor (NDD) kidney transplant (NDDKT) continues to improve organ access for waitlisted candidates. Although NDDs are becoming increasingly common, there has been no contemporary evaluation of NDD allograft use, and it is vital to understand sociodemographic, as well as center-level, use across the US.
Using national data from the Scientific Registry for Transplant Recipients, this study characterized NDDs, NDDKT recipients, and center-level distribution of NDDKT. Directed donor and NDD characteristics were compared using Fisher's exact and Wilcoxon rank-sum tests for categorical and continuous variables, respectively. Multivariable logistic regression was used to identify characteristics associated with receiving NDDKT, and center distribution of NDDKT was assessed using the Gini coefficient.
NDDKT increased from 1.4% (n = 154) of all living donor kidney transplants in 2010 to 6.5% (n = 338) in 2020. Compared with directed living donors, NDDs were older (median [IQR], 44 [33 to 54] vs 43 [33 to 52], p < 0.01), more often male (40.2% vs 36.7%, p < 0.001), and White (91.4% vs 69.5%, p < 0.001). White adult candidates were more likely to receive NDDKT compared with Black (adjusted odds ratio [aOR], 0.300.340.39, p < 0.001), Hispanic/Latino (aOR, 0.360.420.48, p < 0.001), and Other (aOR, 0.410.470.55, p < 0.001) candidates. Black pediatric candidates had lower odds of receiving NDDKT (aOR, 0.090.220.54, p = 0.02). The proportion of centers performing NDDKT has increased from 2010 to 2020 (Gini = 0.77 vs 0.68).
Although more centers are performing NDDKT, racial disparities persist among NDDs and NDDKT recipients. Continued effort is needed to recruit living kidney donors and improve access to living donation for minority groups in the US. (J Am Coll Surg 2022;234:000-00. © 2022 by the American College of Surgeons).
非定向捐赠者（NDD）肾移植（NDDKT）持续改善了等待名单上候选人的器官获取情况。尽管NDD越来越普遍，但目前尚无对NDD同种异体移植物使用情况的当代评估，了解美国各地社会人口统计学以及中心层面的使用情况至关重要。
本研究利用移植受者科学登记处的全国数据，对NDD、NDDKT受者以及NDDKT的中心层面分布进行了特征描述。分别使用Fisher精确检验和Wilcoxon秩和检验对定向捐赠者和NDD的分类变量和连续变量特征进行比较。多变量逻辑回归用于确定与接受NDDKT相关的特征，并使用基尼系数评估NDDKT的中心分布情况。
NDDKT在2010年占所有活体供肾移植的1.4%（n = 154），到2020年增至6.5%（n = 338）。与定向活体供者相比，NDD年龄更大（中位数[四分位间距]，44[33至54]岁对43[33至52]岁，p < 0.01），男性比例更高（40.2%对36.7%，p < 0.001），且为白人的比例更高（91.4%对69.5%，p < 0.001）。与黑人（调整优势比[aOR]，0.30 0.34 0.39，p < ＜0.001）、西班牙裔/拉丁裔（aOR，0.36 0.42 0.48，p < 0.001）和其他（aOR，0.41 0.47 0.55，p < 0.001）候选人相比，白人成年候选人接受NDDKT的可能性更大。黑人儿科候选人接受NDDKT的几率较低（aOR，0.09 0.22 0.54，p = 0.02）。2010年至2020年期间，开展NDDKT的中心比例有所增加（基尼系数 =从从0.77降至0.68）。
尽管有更多中心开展NDDKT，但NDD和NDDKT受者之间的种族差异依然存在。在美国，仍需继续努力招募活体肾供者，并改善少数群体获得活体捐赠的机会。（《美国外科医师学会杂志》2022年；234:000－000。©2022年，美国外科医师学会）
