Díaz J M, Guirado Ll, Facundo C, García-Maset R, Solà R
Unitat Transplantament Renal, Servicio de Nefrología, Fundación Puigvert, Barcelona.
Nefrologia. 2005;25 Suppl 2:51-6.
The goal of the donor evaluation is to ensure the suitability, safety and well being of the donor. In order to avoid important omissions, the evaluation of potential living kidney donors should be carried according to a protocol that includes a logical sequence of complementary explorations. Old age alone is not an absolute contraindication to donation but the evaluation should be more rigorous, because increased age may be associated with more post-operative complications after nephrectomy and renal function and long term graft survival could be shorter than the ones obtained from younger living donors. A body mass index of more than 35 kg/m2 should be an absolute contraindication to renal donation. Between 30 and 35 kg/m2 the donor evaluation should be more rigorous and it should be recommended to lose weight before nephrectomy. Hypertension is one of the most common reasons to declare a potential kidney donor unsuitable. Evidence of organ damage is an absolute contraindication to kidney donation. The donation is only reasonable when hypertension is well controlled with less than two drugs. To excluded diabetes mellitus all donors should have a fasting plasma glucose measurement. Diabetes mellitus is an absolute contraindication to living donation such as an impaired glucose tolerance or impaired fasting glucose with a family history of type 2 diabetes mellitus. Another contraindication to living donation is malignant disease, and the same standards should be adopted for cadaveric donors. The exceptions are low-grade non-melanoma skin cancer and carcinoma in situ of the uterine cervix. The presence of active infection usually precludes donation. It is very important to perform a routine test for viral infections. HIV, hepatitis B and C infection of the donor are usually a contraindication to living donor. CMV donor and recipient status should be taken into account before transplantation, and the recipients at risk for CMV disease should recieve prophylactic treatment according to the transplant unit policy.
供体评估的目的是确保供体的适用性、安全性和健康状况。为避免重大遗漏，对潜在活体肾供体的评估应按照包含一系列互补性检查的合理顺序进行。仅高龄本身并非捐赠的绝对禁忌证，但评估应更严格，因为年龄增长可能与肾切除术后更多的术后并发症相关，且肾功能和长期移植物存活期可能短于年轻活体供体。体重指数超过35kg/m²应是肾脏捐赠的绝对禁忌证。体重指数在30至35kg/m²之间时，对供体的评估应更严格，且建议在肾切除术前减重。高血压是宣布潜在肾供体不适合的最常见原因之一。有器官损害证据是肾脏捐赠的绝对禁忌证。仅在高血压用少于两种药物就能良好控制时，捐赠才是合理的。为排除糖尿病，所有供体均应进行空腹血糖测量。糖尿病是活体捐赠的绝对禁忌证，如糖耐量受损或空腹血糖受损且有2型糖尿病家族史。活体捐赠的另一个禁忌证是恶性疾病，尸体供体也应采用相同标准。例外情况是低度非黑色素瘤皮肤癌和子宫颈原位癌。存在活动性感染通常会排除捐赠。进行病毒感染的常规检测非常重要。供体感染HIV、乙型肝炎和丙型肝炎通常是活体供体的禁忌证。移植前应考虑巨细胞病毒供体和受体的状态，有巨细胞病毒疾病风险的受体应根据移植单位的政策接受预防性治疗。
