Sandikçi Burhaneddin, Ulukuş M Yasin, Ergün Mehmet Ali, Tanriöver Bekir
Department of Industrial Engineering, Istanbul Technical University, Istanbul, Türkiye.
Division of Nephrology, College of Medicine, University of Arizona, Tucson, AZ.
Transplant Direct. 2024 May 17;10(6):e1622. doi: 10.1097/TXD.0000000000001622. eCollection 2024 Jun.
Cytomegalovirus (CMV) infects >60% of adults and can pose an independent risk factor for allograft loss and mortality in solid organ transplant recipients. The purpose of this study is to evaluate the impact of a nationwide implementation of CMV seromatching (donor/recipient: D-/R- and D+/R+) in the U.S. deceased donor kidney allocation system (KAS).
Adult candidates on the U.S. kidney-only transplant waiting list and deceased donor kidneys offered to the U.S. transplant centers were considered. A discrete-event simulation model, simulating the pre-COVID-19 period from January 1, 2015, to January 1, 2018, was used to compare the performances of currently employed KAS-250 policy (without CMV matching) to various simulated CMV matching policies parameterized by calculated panel reactive antibody exception threshold. Outcomes included CMV serodistribution, waiting time, access to transplantation among various groups, transplant rate, graft survival, kidney discard rate, and antigen-mismatch distribution, stratified by CMV serostatus.
CMV matching policy with a calculated panel reactive antibody exception threshold of 50% (namely, the policy) strikes a better balance between benefits and drawbacks of CMV matching. Compared with KAS-250, reduced CMV high-risk (D+/R-) transplants (6.1% versus 18.1%) and increased CMV low-risk (D-/R-) transplants (27.2% versus 13.1%); increased transplant rate for CMV R- patients (11.54 versus 12.57) but decreased for R+ patients (10.68 versus 10.48), yielding an increase in aggregate (11.09 versus 10.94); and reduced mean time to transplantation (by 6 wk); and reduced kidney discard rate (25.7% versus 26.2%).
Our findings underscore the feasibility and potential advantages of a nationwide CMV seromatching policy in kidney transplantation.
巨细胞病毒（CMV）感染了超过60%的成年人，并且可能成为实体器官移植受者移植器官丧失和死亡的独立危险因素。本研究的目的是评估在美国已故供体肾脏分配系统（KAS）中全国范围内实施CMV血清学匹配（供体/受体：D-/R-和D+/R+）的影响。
考虑了美国仅肾脏移植等待名单上的成年候选者以及提供给美国移植中心的已故供体肾脏。使用离散事件模拟模型，模拟2015年1月1日至2018年1月1日的COVID-19大流行前时期，以比较当前采用的KAS-250政策（无CMV匹配）与由计算得出的群体反应性抗体例外阈值参数化的各种模拟CMV匹配政策的性能。结果包括CMV血清分布、等待时间、不同群体之间的移植机会、移植率、移植物存活率、肾脏丢弃率以及抗原错配分布，按CMV血清状态分层。
计算得出的群体反应性抗体例外阈值为50%的CMV匹配政策（即 政策）在CMV匹配的利弊之间取得了更好的平衡。与KAS-250相比， 减少了CMV高风险（D+/R-）移植（6.1%对18.1%），增加了CMV低风险（D-/R-）移植（27.2%对13.1%）；增加了CMV R-患者的移植率（11.54对12.57），但R+患者的移植率降低（10.68对10.48），总体移植率增加（11.09对10.94）；并缩短了平均移植时间（缩短6周）；以及降低了肾脏丢弃率（25.7%对26.2%）。
我们的研究结果强调了在肾脏移植中全国范围内实施CMV血清学匹配政策的可行性和潜在优势。
