改变的捐赠者池是否解释了最近美国脏不使用率的上升?
Keighly Bradbrook1, David Klassen1, Allan B Massie2
1United Network for Organ Sharing, Richmond, Virginia, USA.
概括
已故捐赠的不使用率正在上升,这主要是由于捐赠人数的不断扩大. 分配政策必须适应多样化的捐赠者质量谱,以提高移植效率.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學.
- 移植科学 移植科学
- 公共卫生 公共卫生
背景情况:
- 恢复过来的已故捐赠脏用于移植的非使用率 (NUR) 已经增加,到2023年达到28%.
- 以前的研究将2000年代初的NUR增加与不断扩大的捐赠池联系起来.
研究的目的:
- 评估捐赠者临床特征的变化在多大程度上解释了最近脏不使用率的增加.
- 通过因果推断方法分析2010-2023年不使用的趋势.
主要方法:
- 2010-2023年利用的器官采购和移植网络数据.
- 应用因果推理方法,包括回归和倾向权重,以调整供体因素.
- 2018年至2023年间,未调整和调整后的未使用的概率进行比较.
主要成果:
- 与2018年相比,2023年未调整的不使用的几率高出63%.
- 在调整了供体因素后,不使用的几率仅增加了12%.
- 最近NUR增加的75%到80%归因于不断扩大的捐赠者池,对于高于平均质量的脏来说,NUR很低.
结论:
- 不断扩大和变得越来越多异质的捐赠者池解释了最近脏不使用率的增加.
- 对于风险最高的捐赠脏,无法解释的~30%的非使用风险增加表明潜在的残留混因素或系统级因素.
- 调整分配政策以适应捐赠者质量范围对于提高置部署效率至关重要.
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