Department of Pediatrics, University of Wisconsin Madison, Madison, Wisconsin, USA.
Department of Pediatrics, University of Washington, Seattle, Washington, USA.
Pediatr Transplant. 2022 Nov;26(7):e14369. doi: 10.1111/petr.14369. Epub 2022 Aug 2.
A new Kidney Allocation System (KAS) was implemented in the United States in 2014 with the goal of improving equity and utility.
In this study, we compare outcomes for kidney-alone candidates less than 18 years of age, at the time of listing, in the 5 years prior to and following policy implementation using Organ Procurement and Transplantation Network data.
While the pediatric deceased donor transplant rate increased under KAS, this increase was due solely to improved access for children aged 11-17 years; there was an 18.9% decrease in the deceased donor transplant rate among children 0-5 years old, from 117.94 to 95.8 transplants per 100 person-years (p = .001). The cumulative incidence of deceased donor transplantation by 1 year after listing decreased from 39.3% in the pre-KAS era to 35.5% in the post-KAS era (p = .004), a decline that was driven entirely by longer wait times for children 0-5 years old (p = .017). Candidates with a calculated panel reactive antibody of 98%-100% experienced a significant increase in transplant rate, but there was no change in transplant rate for Black or Hispanic candidates.
Overall, KAS increased transplantation access for teenaged and highly sensitized candidates but resulted in decreased access for the youngest children with no improvement in racial/ethnic equality.
2014 年，美国实施了一种新的肾脏分配系统（KAS），旨在提高公平性和实用性。
本研究利用器官获取与移植网络数据，比较了在政策实施前和实施后 5 年内，18 岁以下、等待移植时为单人肾源的候选人的结局。
尽管 KAS 实施后，儿童的死亡供体移植率有所增加，但这一增长仅归因于 11-17 岁儿童获得机会的改善；0-5 岁儿童的死亡供体移植率下降了 18.9%，从每 100 人年 117.94 例降至 95.8 例（p = 0.001）。与 KAS 实施前相比，KAS 实施后，等待名单 1 年后死亡供体移植的累积发生率从 39.3%下降至 35.5%（p = 0.004），这一降幅完全由 0-5 岁儿童等待时间延长导致（p = 0.017）。计算出的 panel reactive antibody 为 98%-100%的候选人移植率显著增加，但黑人和西班牙裔候选人的移植率没有变化。
总体而言，KAS 增加了青少年和高度敏感候选人的移植机会，但导致最小的儿童获得机会减少，种族/民族平等没有改善。
