[ad_1]
MONDAY, Oct. 29, 2018 (HealthDay News) – A new study says the United States may want to follow in the footsteps of donating kidneys to help desperate patients on waiting lists.
There is worldwide shortage of donor-donated kidneys available for transplantation, but France appears to have been more aggressive than the US in responding to this shortage, said co-author of the study, Peter Reese. He is a physician specializing in kidney transplants and associate professor at the Perelman School of Medicine at the University of Pennsylvania.
The study shows that France uses much older donor kidneys, on average, than in the United States.
"Basically, they accept the kidneys of donors whose quality and risk are much lower," said Reese. "For me, this shows that this other country with a very advanced health system that looks a lot like ours in many ways pushes the envelope on the donors and transplants they're going to do, while this is not the case. "
In the United States, more than 95,000 people are on the waiting list for kidney transplants, according to the United Network for Organ Sharing (UNOS), the non-profit organization that manages the system. of organ transplantation in America.
Despite this shortage, about 2,000 donated kidneys are eliminated each year, researchers said.
"In the United States, many kidneys are harvested, but not transplanted," said Dr. David Klassen, UNOS Medical Officer. "From what we can say, there are some who, in our opinion, could really be transplanted and should be."
To better understand the problem, Reese collaborated with a French research team to compare the relative health of kidneys donated in each country and how organs are used.
The researchers evaluated transplant data from 2004 to 2014, during which more than 156,000 kidneys in the United States and nearly 30,000 kidneys in France were removed for transplantation.
A much higher proportion of kidneys were high-risk organs in France, obtaining an average of 65 on the Kidney Donor Profile Index (KDPI), compared to an average score of 42 for US kidneys used in transplantation.
The lowest scores are associated with a longer function. For example, kidneys with KDPI between 0 and 20 should work an average of 11.5 years, while those with a KDPI between 21 and 85 should work for about 9 years, according to the federal network of obtaining and organ transplantation.
The researchers found that French surgeons generally accept kidneys for transplantation.
"The average age of French donors was 17 years higher than that of the United States," said Reese. "They are responding to the organ crisis by accepting older and older donors."
Kidneys accepted in France also tend to come from donors with more chronic diseases such as high blood pressure and diabetes, said Reese.
As a result, the average French KDPI rose from 54 to 67 over the decade, while the average US KDPI only increased from 42 to 44.
"In ten years in the United States, there has been no change in the age of donors and the quality of donors," Reese said.
The United States could better match the kidneys to the recipients, even if the organs are not of the best quality, concluded Reese.
He gave the example of a kidney given by an 80 year old person.
"It would be a mistake to take this kidney in the United States if the recipient is 30, but we have people over 70 on our waiting list for a kidney transplant," said Reese. "If we were doing a lot of work, I do not think we would have too much trouble finding the right recipients for those kidneys from older donors."
Klassen, who did not participate in the study, said US transplant centers tended to be risk-averse because they did not want to go against the regulators and endanger their certification.
"Transplant organs that might be considered higher risk in potential recipients may be considered higher risk, transplant centers consider this something they choose not to do", said Klassen.
To be fair, some donated organs simply should not be taken. "It's not because a kidney is bought and can possibly be grafted," Klassen said.
There are also major differences in the organ donation and transplantation system between France and the United States, as to how the quality of organs is judged and the kidneys are biopsied at the time of delivery. Supply of organs. "It's hard to say that the results of one country would directly affect another country," said Klassen.
But US Medicare centers and Medicaid services tacitly acknowledged that there was a surveillance problem. The agency released for comment a rule change that would loosen its monitoring criteria, said Klassen.
"They would look at other measures of the quality of the program and not specifically focus on results for one-year-old patients as the only measure of program quality," said Klassen. "I do not think the monitoring of patient outcomes and transplants will ever go away, but I think using a broader range of quality measures would be a good thing to do to judge programs. of transplant. "
The study was to be presented Sunday at the annual meeting of the American Society of Nephrology, in San Diego. Such research is considered preliminary until it is published in a peer-reviewed journal.
More information
The Organ Acquisition and Transplant Network says more about the Renal Donor Profile Index.
SOURCES: Peter Reese, MD, Associate Professor, Perelman School of Medicine, University of Pennsylvania, Philadelphia; David Klassen, MD, Chief Medical Officer, United Network for Organ Sharing; October 28, 2018, presentation, annual meeting of the American Society of Nephrology, San Diego
[ad_2]Source link
