连续分配：扩展标准供体肾脏和儿科肾脏候选者的问题。

Continuous allocation: The problem with EPTS and pediatric kidney candidates.

作者信息

Engen Rachel M, Weiss Samantha, Peterson Caitlin G

机构信息

Department of Pediatrics, University of Wisconsin Madison, Madison, Wisconsin, USA.

United Network for Organ Sharing, Richmond, Virginia, USA.

出版信息

Pediatr Transplant. 2023 Nov;27(7):e14608. doi: 10.1111/petr.14608. Epub 2023 Sep 12.

DOI:10.1111/petr.14608

PMID:37697939

Abstract

BACKGROUND

The 2014 Kidney Allocation System (KAS) introduced longevity matching for adult candidates using the Estimated Post-Transplant Survival (EPTS) score, which includes candidate age, time on dialysis, diabetes status, and number of previous solid organ transplants. The proposed continuous distribution framework may expand the use of this attribute to pediatric candidates, but there is no data on its performance among pediatric kidney transplant recipients.

METHODS

We performed a retrospective cohort study of 6800 pediatric kidney transplant recipients from 2001 to 2011 using Organ Procurement and Transplantation Network (OPTN) data. EPTS score was calculated for each patient and compared to reported patient survival to estimate the validity of the score in children.

RESULTS

The median age of patients was 14.01 years (IQR 9.29-16.37 years), and dialysis vintage was 0.67 years (IQR 0-1.82 years). 18.2% of the cohort had a prior transplant and 1% had diabetes. Median EPTS score was 2 (IQR 1-2). Seven percent of patients died during the study period and 54.7% of the cohort was censored prior to 10 years. The c-statistic was 0.505 (95% CI: 0.49-0.53).

CONCLUSION

Overall, EPTS is not a valid predictor of patient survival among pediatric kidney transplant recipients.

摘要

背景

2014年肾脏分配系统（KAS）引入了使用估计移植后生存期（EPTS）评分对成年候选者进行寿命匹配，该评分包括候选者年龄、透析时间、糖尿病状态以及既往实体器官移植次数。所提议的连续分布框架可能会将此属性的应用扩展到儿科候选者，但尚无关于其在儿科肾移植受者中表现的数据。

方法

我们利用器官获取与移植网络（OPTN）数据，对2001年至2011年期间6800名儿科肾移植受者进行了一项回顾性队列研究。计算每名患者的EPTS评分，并与报告的患者生存期进行比较，以评估该评分在儿童中的有效性。

结果

患者的中位年龄为14.01岁（四分位间距9.29 - 16.37岁），透析时间为0.67年（四分位间距0 - 1.82年）。队列中有18.2%的患者曾接受过移植，1%的患者患有糖尿病。EPTS评分中位数为2（四分位间距1 - 2）。7%的患者在研究期间死亡，54.7%的队列在10年之前被截尾。c统计量为0.505（95%置信区间：0.49 - 0.53）。