Optimizing kidney allocation: challenges and solutions.

IF 1.8 4区 医学 Q3 TRANSPLANTATION
Darren E Stewart, Loren Gragert, Michal A Mankowski
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引用次数: 0

Abstract

Purpose of review: With the kidney nonuse rate approaching 30%, one-fifth of kidneys placed out of sequence, and unsatisfactory long-term recipient outcomes, U.S. kidney allocation is at a crossroads. This review highlights recent studies and efforts geared toward improving the system.

Recent findings: The Organ Procurement & Transplantation Network's kidney transplantation committee is tasked with migrating kidney allocation policy, currently based on 250 nautical mile circles, to a fully continuous, points-based system. Challenges in designing a system assured to improve, not worsen, placement efficiency have hampered progress. OPO and transplant center practice patterns have adapted to a rapidly changing donation landscape. Advances in transplant immunology, particularly involving molecular HLA typing methods, are opening doors for more precise donor-recipient matching that appear to hold promise for improved long-term outcomes.

Summary: The largely one-size-fits-all kidney allocation system is in desperate need of an overhaul. The continuous distribution paradigm is flexible enough to accommodate bold, new ideas for addressing major pain points in an equitable way. The OPTN should use policy variances to conduct time-limited, controlled experiments with various continuous distribution policies and build upon what works. Advances in transplant immunology, such as eplet matching, should increasingly be incorporated into kidney offer decision-making and, eventually, the allocation algorithm.

优化肾脏分配:挑战与解决方案。
回顾目的:随着肾脏不使用率接近30%,五分之一的肾脏排列顺序混乱,以及不令人满意的长期接受者结果,美国肾脏分配正处于十字路口。这篇综述强调了最近的研究和为改进该系统所做的努力。最近的发现:器官获取和移植网络肾移植委员会的任务是将目前基于250海里圈的肾脏分配政策迁移到一个完全连续的、基于点数的系统。在设计一个保证提高(而不是恶化)安置效率的系统方面所面临的挑战阻碍了进展。OPO和移植中心的实践模式已经适应了快速变化的捐赠环境。移植免疫学的进展,特别是涉及HLA分子分型方法的进展,为更精确的供体-受体匹配打开了大门,这似乎有望改善长期结果。摘要:基本上一刀切的肾脏分配系统迫切需要改革。持续分布模式足够灵活,可以适应大胆的新想法,以公平的方式解决主要的痛点。OPTN应该利用政策差异对各种连续分配政策进行有时间限制的、可控的实验,并以有效的政策为基础。移植免疫学方面的进展,如eplet匹配,应该越来越多地纳入肾脏供应决策,并最终纳入分配算法。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
4.10
自引率
4.50%
发文量
124
审稿时长
6-12 weeks
期刊介绍: ​​​​​​Current Opinion in Organ Transplantation is an indispensable resource featuring key, up-to-date and important advances in the field from around the world. Led by renowned guest editors for each section, every bimonthly issue of Current Opinion in Organ Transplantation delivers a fresh insight into topics such as stem cell transplantation, immunosuppression, tolerance induction and organ preservation and procurement. With 18 sections in total, the journal provides a convenient and thorough review of the field and will be of interest to researchers, surgeons and other healthcare professionals alike.
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