Nordén G, Lennerling A, Nyberg G
Division D, Sahlgrenska University Hospital, Göteborg, Sweden.
Transplantation. 2000 Nov 15;70(9):1360-2. doi: 10.1097/00007890-200011150-00016.
There is no defined lower acceptable level of glomerular filtration rate (GFR) in potential living kidney donors. Considerations focus on the risk for the donor. We wanted to evaluate the outcome in the recipient in relation to the GFR of the living donor.
There were 344 living donated kidney transplantations performed January 1985 through February 1997 which were evaluated. Two thirds of the donors shared one haplotype with the recipient and 15% shared both. Of the donors 18% were above age 60. The median follow-up time (until graft loss) was 63 months. Before nephrectomy, the donors' GFR had been measured by isotope clearance.
Twenty-six donors (7.6%) had an absolute GFR below 80 ml/min, i.e. not adjusted to 1.73 m2 body surface area (BSA). Cumulative graft survival, censored for graft loss because of death of the patient, was significantly reduced in recipients of grafts from donors with GFR <80 ml/min. A significant correlation between GFR and donor age was observed, but donor age per se was not identified as a risk factor for graft loss. In a Cox stepwise proportional hazards analysis, the relative risk for graft loss was 2.28 with a GFR below 80 ml/min (confidence interval 1.183-4.383, P=0.014) and with sharing one or both haplotypes 0.56 (0.313-0.988, P=0.046) and 0.36 (0.139-0.912, P=0.03), respectively.
An absolute GFR below 80 ml/min in the living donor more than doubles the risk of graft loss. This fact should be considered when definitions of acceptable limits for donor GFR are discussed.
对于潜在的活体肾供体，目前尚无明确的可接受的肾小球滤过率（GFR）下限。考虑的重点在于供体的风险。我们希望评估活体供体的GFR与受体结局之间的关系。
对1985年1月至1997年2月期间进行的344例活体肾移植进行了评估。三分之二的供体与受体共享一个单倍型，15%的供体与受体共享两个单倍型。18%的供体年龄在60岁以上。中位随访时间（直至移植肾失功）为63个月。在肾切除术前，通过同位素清除法测量供体的GFR。
26例供体（7.6%）的绝对GFR低于80 ml/min，即未根据1.73 m²体表面积（BSA）进行校正。因患者死亡导致移植肾失功而进行截尾后的累积移植肾存活率，在接受GFR<80 ml/min供体的移植肾受体中显著降低。观察到GFR与供体年龄之间存在显著相关性，但供体年龄本身未被确定为移植肾失功的危险因素。在Cox逐步比例风险分析中，GFR低于80 ml/min时移植肾失功的相对风险为2.28（置信区间1.183 - 4.383，P = 0.014），共享一个或两个单倍型时移植肾失功的相对风险分别为0.56（0.313 - 0.988，P = 0.046）和0.36（0.139 - 0.912，P = 0.03）。
活体供体的绝对GFR低于80 ml/min会使移植肾失功的风险增加一倍多。在讨论供体GFR可接受限度的定义时应考虑这一事实。
