Schweitzer E J, Wilson J, Jacobs S, Machan C H, Philosophe B, Farney A, Colonna J, Jarrell B E, Bartlett S T
Joseph and Corrine Schwartz Division of Transplantation, Department of Surgery, University of Maryland, Baltimore, Maryland, USA.
Ann Surg. 2000 Sep;232(3):392-400. doi: 10.1097/00000658-200009000-00011.
To examine the impact of laparoscopic nephrectomy and recipient education on the proportion of kidney recipients who could identify a potential live donor, and on the live donor (LD) transplantation rate.
Laparoscopic donor nephrectomy (LDN) results in less postoperative surgical pain, a shorter hospital stay, and quicker recovery than the standard open donor nephrectomy (ODN). The authors hypothesized that the availability of this less invasive surgical technique would enhance the willingness of family and friends to donate.
The study population consisted of 3,298 end-stage renal disease patients referred for kidney transplant evaluation between November 1991 and February 2000, divided into three groups. The first group received no formal LD education and had only ODN available. The second group received formal education about the LD process and had only ODN available. The third group had both formal LD education and LDN available. Records were examined to determine what proportion of each group had any potential donors tissue-typed, and the rate at which they received an LD transplant.
Before LDN availability and formal LD education, only 35.1% of referrals found a potential donor, and only 12.2% received an LD transplant within 3 years. Institution of a formal education program increased the volunteer rate to 39.0%, and 16.5% received an LD transplant. When LDN became available, 50% of patients were able to find at least one potential donor, and within 3 years 24.7% received an LD transplant. Regression analysis indicated that availability of LDN was independently associated with a 1.9 relative risk of receiving an LD transplant. Kaplan-Meier death-censored 1- and 3-year graft survival rates for ODN transplants were 95.8% and 90.6%, versus 97.5% and 94. 8% for LDN.
The availability of LDN and an LD family education program has doubled the live donor transplantation rate, and outcomes remain excellent.
探讨腹腔镜肾切除术及受者教育对能够确定潜在活体供者的肾移植受者比例以及活体供者（LD）移植率的影响。
与标准开放性供肾切除术（ODN）相比，腹腔镜供肾切除术（LDN）术后手术疼痛较轻、住院时间较短且恢复较快。作者推测，这种侵入性较小的手术技术的应用将提高家人和朋友捐赠的意愿。
研究人群包括1991年11月至2000年2月期间转诊进行肾移植评估的3298例终末期肾病患者，分为三组。第一组未接受正式的活体供者教育，仅可选择ODN。第二组接受了关于活体供者流程的正式教育，仅可选择ODN。第三组既接受了正式的活体供者教育，又可选择LDN。检查记录以确定每组中有多少比例的患者进行了潜在供者的组织配型，以及他们接受活体供者移植的比例。
在LDN可用及正式的活体供者教育开展之前，只有35.1%的转诊患者找到了潜在供者，且只有12.2%的患者在3年内接受了活体供者移植。开展正式教育项目后，自愿捐赠率提高到了39.0%，16.5%的患者接受了活体供者移植。当LDN可用时，50%的患者能够找到至少一名潜在供者，且在3年内24.7%的患者接受了活体供者移植。回归分析表明，LDN的可用性与接受活体供者移植的相对风险为1.9独立相关。ODN移植的Kaplan-Meier死亡校正1年和3年移植物存活率分别为95.8%和90.6%，而LDN移植的分别为97.5%和94.8%。
LDN的可用性及活体供者家庭教育项目使活体供者移植率提高了一倍，且结果仍然良好。
