John C. McDonald Regional Transplant Center, Willis-Knighton Medical Center, Shreveport, Louisiana, USA.
University of Minnesota, Saint Paul, Minnesota, USA.
Clin Transplant. 2022 Nov;36(11):e14797. doi: 10.1111/ctr.14797. Epub 2022 Sep 9.
Donor service area was removed from kidney and pancreas allocation system in the United States on March 15, 2021 in favor of a distance based policy to provide geographic equity to access to transplantation. The policy change was introduced at a time when ongoing Coronavirus Disease 2019 (COVID-19) pandemic cases were declining following the first delta wave.
In this Scientific Registry of Transplant Recipients based study, deceased donor kidney transplant recipients between March 15 and December 2 of 2019, 2020 and 2021 were compared representing pre-policy change, pre-COVID cohort; pre-policy change, early COVID cohort; and post-policy change, late COVID cohort.
There were 11336, 11808, and 12914 kidney transplants in the 2019, 2020, and 2021 cohorts, respectively. Proportion of kidney transplants increased from 8798 (78%) to 9496 (80%) to 11152 (86%), and decreased from 2538 (22%) to 2312 (20%) to 1762 (14%) within and beyond 250 nautical miles in subsequent years. Median distance between donor and transplant hospital increased (73 vs. 63 vs. 119 nautical miles, P < .001) and mean cold ischemia time increased (18.1 vs. 17.8 vs. 19.9 h, P < .001). Access to transplantation did not change for various racial groups (P = .07), pediatric patients (P = .29), dialysis vintage of >5 years (P = .21), veterans (P = .07) and decreased for those with calculated PRA of 99% and 100% (P < .001). Rate of kidney discard (19.6% vs. 20.4% vs. 24%) remained high. Although there were numerical increases in transplants from donors with donation after circulatory death, donor acute kidney injury, kidney donor profile index >85% and donor age >60 years in successive years, rates of kidney discard also increased proportionally.
Improvement in the access to transplantation following the policy change was attenuated by the concurrent prevalence of the COVID-19 pandemic.
2021 年 3 月 15 日，美国取消了肾脏和胰腺分配系统中的供体服务区，转而采用基于距离的政策，为移植提供地理公平。这一政策变化是在第一波德尔塔浪潮过后，持续的 2019 年冠状病毒病（COVID-19）病例下降之际推出的。
在这项基于移植受者科学登记处的研究中，比较了 2019 年 3 月 15 日至 12 月 2 日、2020 年和 2021 年接受过已故供体肾脏移植的患者，分别代表政策变化前、COVID 前队列；政策变化前、COVID 早期队列；以及政策变化后、COVID 晚期队列。
2019 年、2020 年和 2021 年分别有 11336、11808 和 12914 例肾脏移植。肾脏移植的比例从 8798（78%）增加到 9496（80%）再增加到 11152（86%），从 2538（22%）减少到 2312（20%）再减少到 1762（14%）在随后的几年中，在 250 海里以内和以外。供体与移植医院之间的中位数距离增加（73 与 63 与 119 海里，P<.001），平均冷缺血时间增加（18.1 与 17.8 与 19.9 小时，P<.001）。不同种族群体（P=0.07）、儿科患者（P=0.29）、透析年限>5 年（P=0.21）、退伍军人（P=0.07）的移植机会没有变化，而计算的 PRA 为 99%和 100%的患者（P<.001）的移植机会减少。肾脏废弃率（19.6%与 20.4%与 24%）仍然很高。尽管在连续几年中，来自循环死亡后捐赠、急性肾损伤供体、肾脏捐赠者概况指数>85%和供体年龄>60 岁的供体的移植数量有所增加，但肾脏废弃率也相应增加。
在 COVID-19 大流行同时流行的情况下，政策变化后移植机会的改善被削弱。
