Lima Bruno A, Reis Filipe, Alves Helena, Henriques Teresa S
Oficina de Bioestatistica, Transplant Open Registry, Ermesinde, Portugal.
Oficina de Bioestatistica, Transplant Open Registry, Ermesinde, Portugal.
Transpl Immunol. 2023 Dec;81:101917. doi: 10.1016/j.trim.2023.101917. Epub 2023 Aug 9.
There is a general agreement that the distribution of kidneys for transplantation should balance utility criteria with justice. Moreover, a kidney allocation system must be based on transparent policies and seen as an ongoing process. This study aims to present an allocation system grounded on an equity matrix that balances the criteria of utility and justice. Synthetic data for a waiting list with 2000 transplant candidates and a pool of 280 donors were generated. A color priority system, the Eurotransplant (ET) kidney allocation system, and the proposed Equity Matrix (EQM) allocation system were compared after 1000 iterations of kidney allocations. Distributions of variables like the age difference, Human Leukocyte Antigens (HLA) mismatches (mmHLA), recipients' time on dialysis, cPRA, and a transplant score obtained by different allocation models were compared graphically and with Cohen's d effect size. For the analyzed variables, when we compare only the selected recipients from ET with the selected recipients from the EQM neutral model, we can conclude that the former model selects more hypersensitized recipients, a higher number of 65+ years' old recipients with 65+ years' old donors and higher number of recipients with 0 mmHLA. While recipients from EQM neutral are slightly older, have a lower age difference with their donors, have a lower number of mmHLA, are less likely to have 6 mmHLA with their donors, and have more time on dialysis. The proposed EQM model attempts to provide a simple, transparent, and equitable response to a complex question with results that outperform established practices.
人们普遍认为，肾脏移植的分配应在效用标准和公平之间取得平衡。此外，肾脏分配系统必须基于透明的政策，并被视为一个持续的过程。本研究旨在提出一种基于公平矩阵的分配系统，该系统平衡了效用和公平标准。生成了一个包含2000名移植候选者的等待名单和280名供体库的合成数据。在进行1000次肾脏分配迭代后，对颜色优先系统、欧洲移植（ET）肾脏分配系统和拟议的公平矩阵（EQM）分配系统进行了比较。通过图形比较以及使用科恩d效应量，比较了不同分配模型获得的年龄差、人类白细胞抗原（HLA）错配（mmHLA）、受者透析时间、cPRA和移植评分等变量的分布情况。对于所分析的变量，当我们仅将ET系统中选定的受者与EQM中性模型中选定的受者进行比较时，可以得出结论：前一种模型选择了更多高敏受者、更多65岁及以上供体对应的65岁及以上受者以及更多0个mmHLA的受者。而EQM中性模型的受者年龄稍大，与供体的年龄差更小，mmHLA数量更少，与供体有6个mmHLA的可能性更低，且透析时间更长。拟议的EQM模型试图为一个复杂问题提供一个简单、透明且公平的解决方案，其结果优于既定做法。
