Kasiske B L, Snyder J, Matas A, Collins A
United States Renal Data System, United States Renal Data System Coordinating Center, Minneapolis, Minnesota, USA.
Clin Transpl. 2000:135-43.
Although the growth in the incidence and prevalence of ESKD has slowed, there will nevertheless be a substantial increase in the number of patients over the next decade. Indeed, between 1998 and 2010 there will be a doubling in the number of patients in the United States treated with renal replacement therapy. There has also been an increase in the number of new transplants carried out every year. Much of the growth in the number of new transplants has been from the growth in living-unrelated donor transplants. Unfortunately, the rate of increase in the number of new transplants has not been enough to keep pace with the growing number of ESKD patients. As a result, the number of patients on the transplant waiting list continues to increase. The inability to offer more ESKD patients transplantation is unfortunate, since transplantation is associated with improved survival. Indeed, analyses of comparable patients who are placed on the transplant waiting list suggest that transplantation reduces the risk of death by roughly 50%. Thus, it is likely that the overall survival of patients with ESKD will improve if a greater proportion of patients receive transplants in a timely manner. Reducing allograft rejection and the need for repeat transplants may help reduce the demand for donor kidneys. However, this is unlikely to have a major effect on the organ shortage, since the number of repeat transplants has been relatively small (and constant) over the past decade. Thus, only if more cadaveric and living-donor kidneys are made available will more ESKD patients enjoy the improved survival of kidney transplantation.
尽管终末期肾病（ESKD）的发病率和患病率增长已经放缓，但在未来十年患者数量仍将大幅增加。事实上，1998年至2010年期间，美国接受肾脏替代治疗的患者数量将翻倍。每年进行的新移植手术数量也有所增加。新移植手术数量的增长很大程度上源于非亲属活体供体移植的增加。不幸的是，新移植手术数量增长的速度还不足以跟上ESKD患者数量的增长。结果，等待移植名单上的患者数量持续增加。无法为更多ESKD患者提供移植手术很遗憾，因为移植手术与生存率提高相关。确实，对等待移植名单上可比患者的分析表明，移植手术可将死亡风险降低约50%。因此，如果有更大比例的患者及时接受移植手术，ESKD患者的总体生存率可能会提高。减少同种异体移植排斥反应以及重复移植的需求可能有助于减少对供体肾脏的需求。然而，这对器官短缺问题不太可能产生重大影响，因为在过去十年中重复移植手术的数量相对较少（且保持不变）。因此，只有提供更多的尸体供肾和活体供肾，更多的ESKD患者才能享受到肾脏移植带来的生存率提高。
