Department of Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Department of Surgery, Division of Transplantation, The Ohio State University Wexner Medical Center, Columbus, Ohio.
Transplant Proc. 2024 Oct;56(8):1740-1751. doi: 10.1016/j.transproceed.2024.08.010. Epub 2024 Aug 30.
Disparity in waiting time to kidney transplantation led to new policy (KAS250). Our aims were to identify variables associated with long wait time (LWT); assess the impact of KAS250 on WT; and analyze modifiable transplant center behaviors correlated with WT.
SRTR data for adult deceased donor kidney transplants were analyzed. Time-periods from 8/1/2018-7/31/2019 and 5/1/2021-4/30/2022 were chosen for pre- and post-KAS250 analyses. Transplant centers were categorized as LWT or SWT centers depending on whether pre-KAS250 median center waiting times were greater or less than the national pre-KAS250 median waiting time of 57.8 months.
In multivariate analysis, transplantation with HCV NAT negative kidneys was associated with an additional 21.3 months of WT (CI: 18.5-24.2, P < .0001), and transplantation with KDPI <85% kidneys was associated with an additional 10.8 months (CI: 8.2-13.3, P < .0001). Post-KAS250 national kidney transplant waiting time decreased from 61-58 months (P < .0001) and waiting time at LWT centers decreased from 74-69 months (P < .0001). Cold ischemic times (CIT) increased (20.2 hours vs 18.3 hours, P < .0001) and DGF rates also increased (32.7% vs 31.0%, P < .0001). Centers generally displayed more aggressive transplantation practices post-KAS250 however significant differences in DCD utilization, organ offer acceptance ratios and tolerance for long CIT persist between SWT and LWT centers.
KAS250 has reduced waiting time disparities between SWT and LWT centers at the cost of increased CIT and DGF and reduced allocation efficiency. Significant differences in transplant practice persist between SWT and LWT centers.
肾脏移植等待时间的差异导致了新政策（KAS250）的出台。我们的目的是确定与长等待时间（LWT）相关的变量；评估 KAS250 对 WT 的影响；并分析与 WT 相关的可修改的移植中心行为。
对成人尸体供肾移植的 SRTR 数据进行了分析。选择了 2018 年 8 月 1 日至 2019 年 7 月 31 日和 2021 年 5 月 1 日至 2022 年 4 月 30 日两个时间段进行 KAS250 前后的分析。根据中心的预 KAS250 中位等待时间是否大于或小于全国预 KAS250 的中位等待时间 57.8 个月，将移植中心分为 LWT 或 SWT 中心。
在多变量分析中，HCV NAT 阴性肾脏的移植与额外 21.3 个月的 WT 相关（CI：18.5-24.2，P<.0001），KDPI<85%的肾脏的移植与额外 10.8 个月的 WT 相关（CI：8.2-13.3，P<.0001）。KAS250 后，全国肾脏移植等待时间从 61-58 个月（P<.0001）下降，LWT 中心的等待时间从 74-69 个月（P<.0001）下降。冷缺血时间（CIT）增加（20.2 小时对 18.3 小时，P<.0001），DGF 发生率也增加（32.7%对 31.0%，P<.0001）。KAS250 后，中心普遍表现出更积极的移植实践，但 SWT 和 LWT 中心之间在 DCD 利用率、器官提供接受率和对长 CIT 的容忍度方面仍存在显著差异。
KAS250 降低了 SWT 和 LWT 中心之间的等待时间差距，但代价是 CIT 和 DGF 增加，分配效率降低。SWT 和 LWT 中心之间的移植实践仍存在显著差异。
