Zhang Xingyu, Potluri Vishnu S, Molinari Michele, Giuntella Osea, Hariharan Sundaram, Puttarajappa Chethan M
School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
Renal-Electrolyte and Hypertension Division, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Am J Transplant. 2025 Jun;25(6):1253-1263. doi: 10.1016/j.ajt.2024.12.011. Epub 2024 Dec 24.
A new deceased donor kidney allocation system (KAS250) was implemented in March 2021 that prioritizes recipients within a 250-nautical mile radius of the donor hospital. KAS250 was implemented to reduce geographic disparities in access to kidney transplantation. Studies have shown an increase in cold ischemia time (CIT) after KAS250 implementation but the impact on graft outcomes is unknown. Utilizing data from the Scientific Registry of Transplant Recipients, we estimated cause-specific hazards of 1-year death-censored graft loss (DCGL) and all-cause graft loss (ACGL) due to KAS250 for the post-KAS250 period (April 2021 to December 2022; N = 28 584) compared to the pre-KAS250 period (January 2017 to December 2018; N = 23 798). We found that the post-KAS250 period had higher DCGL (hazard ratio 1.14; 95% CI 1.02-1.26; P = 0.0187) and ACGL (hazard ratio 1.22; 95% CI 1.13-1.31, P < .0001). Mediation analysis showed that CIT indirectly mediated 45.54% and 15.73% of KAS250 policy's effect on DCGL and ACGL, respectively. In conclusion, short-term graft outcomes in the post-KAS250 era are inferior to those in the pre-KAS250 era, with the worsening CIT being a significant contributor. Therefore, further adjustments to both the policy and transplant practices should be considered to further optimize equity and outcomes.
一种新的 deceased donor kidney allocation system (KAS250) 于 2021 年 3 月实施，该系统优先考虑供体医院 250 海里半径范围内的受者。实施 KAS250 是为了减少肾移植获取方面的地理差异。研究表明，KAS250 实施后冷缺血时间 (CIT) 有所增加，但对移植结果的影响尚不清楚。利用移植受者科学登记处的数据，我们估计了 KAS250 实施后时期（2021 年 4 月至 2022 年 12 月；N = 28584）与 KAS250 实施前时期（2017 年 1 月至 2018 年 12 月；N = 23798）相比，因 KAS250 导致的特定原因的 1 年死亡审查移植丢失 (DCGL) 和全因移植丢失 (ACGL) 的风险。我们发现，KAS250 实施后时期的 DCGL（风险比 1.14；95% CI 1.02 - 1.26；P = 0.0187）和 ACGL（风险比 1.22；95% CI 1.13 - 1.31，P <.0001）更高。中介分析表明，CIT 分别间接介导了 KAS250 政策对 DCGL 和 ACGL 影响的 45.54% 和 15.73%。总之，KAS250 时代的短期移植结果不如 KAS250 实施前时代，CIT 的恶化是一个重要因素。因此，应考虑对政策和移植实践进行进一步调整，以进一步优化公平性和结果。
