Accelerating kidney allocation: Simultaneously expiring offers.

Autor: Mankowski MA; Computer, Electrical and Mathematical Sciences and Engineering Division, King Abdullah University of Science and Technology, Thuwal, Saudi Arabia., Kosztowski M; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa., Raghavan S; Smith School of Business and Institute for Systems Research, University of Maryland, College Park, Maryland., Garonzik-Wang JM; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland., Axelrod D; Department of Surgery, University of Iowa Carver College of Medicine, Iowa City, Iowa., Segev DL; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland.; Scientific Registry of Transplant Recipients, Minneapolis, Minnesota., Gentry SE; Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.; Scientific Registry of Transplant Recipients, Minneapolis, Minnesota.; Department of Mathematics, United States Naval Academy, Annapolis, Maryland.
Jazyk: angličtina
Zdroj: American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons [Am J Transplant] 2019 Nov; Vol. 19 (11), pp. 3071-3078. Date of Electronic Publication: 2019 May 28.
DOI: 10.1111/ajt.15396
Abstrakt: Using nonideal kidneys for transplant quickly might reduce the discard rate of kidney transplants. We studied changing kidney allocation to eliminate sequential offers, instead making offers to multiple centers for all nonlocally allocated kidneys, so that multiple centers must accept or decline within the same 1 hour. If more than 1 center accepted an offer, the kidney would go to the highest-priority accepting candidate. Using 2010 Kidney-Pancreas Simulated Allocation Model-Scientific Registry for Transplant Recipients data, we simulated the allocation of 12 933 kidneys, excluding locally allocated and zero-mismatch kidneys. We assumed that each hour of delay decreased the probability of acceptance by 5% and that kidneys would be discarded after 20 hours of offers beyond the local level. We simulated offering kidneys simultaneously to small, medium-size, and large batches of centers. Increasing the batch size increased the percentage of kidneys accepted and shortened allocation times. Going from small to large batches increased the number of kidneys accepted from 10 085 (92%) to 10 802 (98%) for low-Kidney Donor Risk Index kidneys and from 1257 (65%) to 1737 (89%) for high-Kidney Donor Risk Index kidneys. The average number of offers that a center received each week was 10.1 for small batches and 16.8 for large batches. Simultaneously expiring offers might allow faster allocation and decrease the number of discards, while still maintaining an acceptable screening burden.
(© 2019 The American Society of Transplantation and the American Society of Transplant Surgeons.)
Databáze: MEDLINE
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