Department of Medicine, University of California at San Diego, San Diego, CA.
Am J Transplant. 2010 Apr;10(4):737-741. doi: 10.1111/j.1600-6143.2010.03023.x. Epub 2010 Feb 25.
Transplant centers medically evaluate potential living kidney donors in part to determine their baseline remaining lifetime risk for end stage renal disease (ESRD). If baseline risk is increased by the presence of a risk factor for ESRD, donation is often refused. However, as only about 13% of ESRD occurs in the general population by age 44, a normal medical evaluation cannot be expected to significantly reduce the 7% lifetime risk for a 'normal' 25-year-old black donor or the 2-3% risk for a similar white donor. About half of newly diagnosed ESRD in the United States occurs by age 65, and about half of that is from diabetic nephropathy, which takes about 25 years to develop. Therefore, the remaining baseline lifetime risk for ESRD is significantly lower in the normal, nondiabetic 55-year-old donor candidate. Some older donors with an isolated medical abnormality such as mild hypertension will be at lower or about the same overall baseline lifetime risk for ESRD as are young 'normal' donor candidates. Transplant centers use a 'normal for now' standard for accepting young donors, in place of the long-term risk estimates that must guide selection of all donors.
移植中心通过医学评估来确定潜在的活体肾脏供者的基线剩余终身终末期肾病（ESRD）风险。如果存在 ESRD 的风险因素，则通常会拒绝捐赠。然而，由于只有约 13%的 ESRD 会在 44 岁之前发生在普通人群中，因此不能期望正常的医学评估能显著降低“正常”25 岁黑人供者的 7%终身风险，也不能降低类似的白人供者的 2-3%风险。在美国，新诊断的 ESRD 中有约一半发生在 65 岁之前，其中约一半是由糖尿病肾病引起的，这种疾病大约需要 25 年才能发展。因此，正常、非糖尿病的 55 岁供者候选人的 ESRD 剩余基线终身风险显著降低。一些有孤立医学异常的老年供者，如轻度高血压，其 ESRD 的总体基线终身风险将低于或与年轻的“正常”供者候选人相同。移植中心使用“目前正常”的标准来接受年轻的供者，而不是必须指导所有供者选择的长期风险估计。
