Department of Nephrology, University Hospital Regensburg, Regensburg, Germany; Eurotransplant Foundation, Leiden, Netherlands; German Organ Procurement Organization (DSO), Frankfurt am Main; Center for Clinical Studies, University Hospital Regensburg, Regensburg, Germany.
Dtsch Arztebl Int. 2023 Jun 9;120(23):393-399. doi: 10.3238/arztebl.m2023.0098.
In order to achieve short ischemia times between organ donation and transplantation, regional organ allocation has been assigned priority in the development of allocation rules for kidney transplantation. It is unclear whether this leads to differences in regional waiting times in Germany.
A retrospective cohort study over a 24-month observation period was conducted, including all patients who received a kidney-only graft allocated via the standard Eurotransplant Kidney Allocation System (ETKAS) (n = 1487) or the Eurotransplant Senior Program (ESP) (n = 566). Multiple linear regression analyses were performed to investigate differences in waiting times across the regions (ETKAS) or subregions (ESP) as defined by the German Organ Procurement Organization (DSO). Associations between the number of regionally procured kidneys (n = 1444) and regional waiting times were investigated.
In ETKAS, the median waiting time was 8.9 years (interquartile range [IQR] 6.7-10.6); in ESP, it was 3.9 (2.4 -5.3) years. Compared with the reference region with the shortest waiting time, waiting times in other regions were 0.6 to 1.7 years longer in ETKAS and 1.3 to 4.4 years longer in ESP. The ratio of the number of patients on the waiting list for a particular region to the number of organs donated in that region was associated with the waiting time in ETKAS (R2 = 0.70). In ESP, this association was markedly less pronounced (R2 = 0.45).
In Germany, waiting times depend strongly on the region where a patient is listed for kidney transplantation, especially in ESP. These findings call the current allocation algorithms into question and imply a need for suitable modification.
为了实现器官捐献和移植之间的短缺血时间，在制定肾移植分配规则时，区域器官分配已被优先考虑。目前尚不清楚这是否会导致德国区域等待时间的差异。
本研究为 24 个月的观察期回顾性队列研究，纳入所有通过标准 Eurotransplant 肾脏分配系统（ETKAS）（n = 1487）或 Eurotransplant 高级计划（ESP）（n = 566）分配的接受单纯肾脏移植的患者。采用多元线性回归分析，以调查德国器官采购组织（DSO）定义的区域（ETKAS）或亚区（ESP）之间的等待时间差异。研究了区域性采集肾脏数量（n = 1444）与区域等待时间之间的相关性。
在 ETKAS 中，中位等待时间为 8.9 年（四分位距 [IQR] 6.7-10.6）；在 ESP 中，中位等待时间为 3.9 年（2.4-5.3）。与等待时间最短的参考区域相比，ETKAS 中其他区域的等待时间长 0.6 至 1.7 年，ESP 中长 1.3 至 4.4 年。特定区域的等待名单上的患者人数与该区域捐赠器官数量的比值与 ETKAS 的等待时间相关（R2 = 0.70）。在 ESP 中，这种相关性明显较弱（R2 = 0.45）。
在德国，患者在肾脏移植等待名单上的区域强烈影响等待时间，尤其是在 ESP 中。这些发现对当前的分配算法提出了质疑，并暗示需要进行适当的修改。
