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A2/A2B 对 B 型已故供者肾移植在肾脏分配系统时代。

A2/A2B to B deceased donor kidney transplantation in the Kidney Allocation System era.

机构信息

Grossman School of Medicine, New York University, New York, New York, USA.

Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.

出版信息

Am J Transplant. 2024 Apr;24(4):606-618. doi: 10.1016/j.ajt.2023.12.015. Epub 2023 Dec 23.

Abstract

Kidney transplantation from blood type A2/A2B donors to type B recipients (A2→B) has increased dramatically under the current Kidney Allocation System (KAS). Among living donor transplant recipients, A2-incompatible transplants are associated with an increased risk of all-cause and death-censored graft failure. In light of this, we used data from the Scientific Registry of Transplant Recipients from December 2014 until June 2022 to evaluate the association between A2→B listing and time to deceased donor kidney transplantation (DDKT) and post-DDKT outcomes for A2→B recipients. Among 53 409 type B waitlist registrants, only 12.6% were listed as eligible to accept A2→B offers ("A2-eligible"). The rates of DDKT at 1-, 3-, and 5-years were 32.1%, 61.4%, and 72.1% among A2-eligible candidates and 14.1%, 29.9%, and 44.1% among A2-ineligible candidates, with the former experiencing a 133% higher rate of DDKT (Cox weighted hazard ratio (wHR) = 2.33; P < .001). The 7-year adjusted mortality was comparable between A2→B and B-ABOc (type B/O donors to B recipients) recipients (wHR 0.94, P = .5). Moreover, there was no difference between A2→B vs B-ABOc DDKT recipients with regards to death-censored graft failure (wHR 1.00, P > .9) or all-cause graft loss (wHR 0.96, P = .6). Following its broader adoption since the implementation of the kidney allocation system, A2→B DDKT appears to be a safe and effective transplant modality for eligible candidates. As such, A2→B listing for eligible type B candidates should be expanded.

摘要

从血型 A2/A2B 供体向 B 受体(A2→B)的肾移植在当前的肾脏分配系统(KAS)下大幅增加。在活体供体移植受者中,A2 不相容的移植与全因和死亡原因排除的移植物失败风险增加相关。有鉴于此,我们使用了 2014 年 12 月至 2022 年 6 月期间来自移植受者科学注册处的数据,评估了 A2→B 列表与接受 A2→B 供体的死亡供体肾移植(DDKT)时间和 A2→B 受体的移植后结果之间的关联。在 53409 名 B 型候补注册者中,只有 12.6%被列为有资格接受 A2→B 供体(“A2 合格”)。在 A2 合格候选者中,1 年、3 年和 5 年的 DDKT 率分别为 32.1%、61.4%和 72.1%,而在 A2 不合格候选者中分别为 14.1%、29.9%和 44.1%,前者的 DDKT 率高 133%(Cox 加权风险比(wHR)=2.33;P<.001)。A2→B 和 B-ABOc(B/O 供体到 B 受体)受体的 7 年调整死亡率相当(wHR 0.94,P=.5)。此外,A2→B 与 B-ABOc DDKT 受者在死亡原因排除的移植物失败(wHR 1.00,P>.9)或全因移植物丢失(wHR 0.96,P=.6)方面没有差异。自肾脏分配系统实施以来,A2→B DDKT 的广泛采用似乎是合格候选者的一种安全有效的移植方式。因此,应扩大符合条件的 B 型候选者的 A2→B 列表。

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