ity points assigned to candidates associated with sensitization have led to inequities in access to deceased donor transplantation. Background A primary change to the national organ allocation system in 2014 for deceased donor kidney offers was to weight candidate priority on the basis of sensitization (i.e., calculated panel reactive antibody percentage [cPRA%]) using a sliding scale. Increased priority for sensitized patients could improve equity in access to transplantation for disadvantaged candidates. We sought to evaluate the effect of these weights using a contemporary cohort of adult US kidney transplant candidates. Methods We used the national Scientific Registry of Transplant Recipients to evaluate factors associated with sensitization using multivariable logistic models and rates of deceased donor transplantation using cumulative incidence models accounting for competing risks and multivariable Cox models. Results We examined 270,912 adult candidates placed on the waiting list between January 2016 and September 2023. Six-year cumulative incidence of deceased donor transplantation for candidates with cPRA%=80–85 and 90–95 was 48% and 53%, respectively, as compared with 37% for candidates with cPRA%=0–20. In multivariable models, candidates with high cPRA% had the highest adjusted hazards for deceased donor transplantation. There was significant effect modification such that the association of high cPRA% with adjusted rates of deceased donor transplantation varied by region of the country, sex, race and ethnicity, prior dialysis time, and blood type. Conclusions The results indicate that the weighting algorithm for highly sensitized candidates may overinflate the need for prioritization and lead to higher rates of transplantation. Findings suggest recalibration of priority weights for allocation is needed to facilitate overall equity in access to transplantation for prospective kidney transplant candidates. However, priority points should also account for subgroups of candidates who are disadvantaged for access to donor offers....

中文翻译：

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美国肾移植候选者致敏状态优先点的校准


分配给与致敏相关的候选者的分数导致了在获得已故捐献者移植方面的不平等。背景 2014 年，国家器官分配系统针对已故捐献肾脏的主要变化是使用滑动标尺根据致敏性（即计算出的面板反应性抗体百分比 [cPRA%]）来权衡候选者的优先级。提高对敏感患者的优先权可以提高弱势候选人获得移植机会的公平性。我们试图利用当代美国成年肾移植候选者队列来评估这些权重的影响。方法 我们利用国家移植受者科学登记系统，使用多变量逻辑模型评估与致敏相关的因素，并使用考虑竞争风险的累积发生率模型和多变量 Cox 模型评估已故供体移植率。结果 我们检查了 2016 年 1 月至 2023 年 9 月期间列入等候名单的 270,912 名成年候选人。对于 cPRA%=80-85 和 90-95 的候选人，已故供体移植的六年累积发生率分别为 48% 和 53%，如下所示相比之下，cPRA%=0–20 的候选人的这一比例为 37%。在多变量模型中，cPRA% 高的候选人对于已故供体移植的调整后风险最高。存在显着的效应修正，例如高 cPRA% 与调整后的已故供体移植率的关联因国家地区、性别、种族和民族、既往透析时间和血型而异。结论 结果表明，针对高度敏感候选者的加权算法可能会过度夸大优先级的需要，并导致更高的移植率。 研究结果表明，需要重新调整分配的优先权重，以促进潜在肾移植候选者获得移植机会的整体公平性。然而，优先点还应考虑到在获得捐助方方面处于不利地位的候选人亚组......