脏配对捐赠和优化活体捐献器官的使用
Dorry L Segev1, Sommer E Gentry, Daniel S Warren
1Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Md.
JAMA
|April 21, 2005
概括
一个优化的国家配捐赠 (KPD) 计划显著增加了移植和移植存活率. 这种先进的匹配方案提高了HLA兼容性,并减少了患者的旅行,为挽救生命的移植提供了更公平的机会.
科学领域:
- 科和移植手术 移植手术
- 免疫遗传学和组织相容性
- 医疗保健服务研究和政策
背景情况:
- 血型和交叉匹配不兼容性将超过三分之一的患者排除在活供体移植之外.
- 配对捐献 (KPD) 促进了不兼容的捐赠者-接受者对的移植,但取得的成功有限.
- 目前的KPD匹配方案不足以最大限度地提高移植机会.
研究的目的:
- 评估增强匹配算法对KPD移植结果的影响.
- 将优化匹配方案与当前的KPD实践进行比较.
- 评估移植数量和质量的增加的潜力.
主要方法:
- 为不兼容的捐赠者/接受者对开发一个模拟模型.
- 设计和实施一个数学优化的匹配算法.
- 优化算法与现有的第一接受方案的比较,使用模拟的患者数据.
主要成果:
- 一个国家优化的匹配算法增加了移植 (47.7%与42.0%) 和5年移植存活率 (34.9%与28.7%).
- 优化匹配显著改善了HLA一致性 (3.0对4.5不匹配的抗原) 并减少了患者的旅行 (2.9%对18.4%).
- 高度敏感的患者在优化国家方案的成功匹配率增加了六倍 (14.1%与2.3%相比).
结论:
- 将国家KPD程序与优化的匹配算法相结合,可以最大限度地实现兼容的移植.
- 优化匹配为捐赠者与接受者匹配优先事项提供了更大的灵活性,并确保了高质量的器官的公平分配.
- 实施一个优化的国家KPD计划可以带来大量的医疗保健成本节省.
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