Hornberger J, Ahn J H
Department of Health Research and Policy, Stanford University School of Medicine, CA 94305-5092, USA.
Med Decis Making. 1997 Apr-Jun;17(2):160-70. doi: 10.1177/0272989X9701700206.
The expectation of transplant success for some patient/donor-kidney matches can be so low that transplantation is not considered an option. The issue may be framed as deciding the minimum expectation of transplant success that would justify a patient's eligibility for transplantation with an available donor kidney. If the minimum is set too high, the patient will be eligible for very few donor kidneys and will wait excessively for transplantation. If the minimum is set too low, the patient has a greater risk of graft failure once transplantation has been done. A decision model calculates the minimum predicted one-year graft survival rate that would determine eligibility for an available donor kidney, with the goal of maximizing quality-adjusted life expectancy. The minimum predicted one-year graft survival rate depends on the patient's health and demographic characteristics and attitudes about quality of life with kidney-replacement therapies. Graft survival rates and quality-adjusted life expectancies may increase by as much 6.7% and 1.6 months, respectively, with only a slight increase (< 0.4 months) in the quality-adjusted waiting time until transplantation.
对于某些患者/供体肾脏匹配情况而言，移植成功的期望可能极低，以至于移植不被视为一种选择。这个问题可以表述为确定移植成功的最低期望，该期望能够证明患者有资格接受可用供体肾脏的移植。如果设定的最低期望过高，患者符合条件的供体肾脏就会很少，并且会过度等待移植。如果设定的最低期望过低，患者在完成移植后发生移植失败的风险就会更大。一个决策模型计算出能决定是否有资格接受可用供体肾脏移植的最低预测一年移植存活率，目标是使质量调整生命预期最大化。最低预测一年移植存活率取决于患者的健康状况、人口统计学特征以及对肾脏替代疗法生活质量的态度。移植存活率和质量调整生命预期可能分别提高多达6.7%和1.6个月，而直到移植的质量调整等待时间仅略有增加（<0.4个月）。
