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Clin J Am Soc Nephrol. 2011 Aug;6(8):2054-9. doi: 10.2215/CJN.03370411. Epub 2011 Jul 22.
As the kidney transplant waiting list grows, the willingness of transplant centers to accept complex donors increases. Guidelines for the evaluation of living kidney donors exist but do not provide clear guidance when evaluating the complex donor. Although few transplant centers will approve donor candidates with impaired glucose tolerance and most, if not all, will deny candidates with diabetes, many will approve candidates with impaired fasting glucose (IFG). Furthermore, the demographic of living donors has changed in the past 10 years to increasingly include more nonwhite and Hispanic individuals who are at greater risk for future diabetes and hypertension. IFG may be more of a concern in potential donors whose nonwhite and Hispanic ethnicity already places them at greater risk. We review the definition of diabetes, diabetes prediction tools, and transplant guidelines for donor screening and exclusion as it pertains to impaired glucose metabolism, and additional ethnic and nonethnic factors to consider. We offer an algorithm to aid in evaluation of potential living donors with IFG in which ethnicity, age, and features of the metabolic syndrome play a role in the decision making.
随着肾移植等待名单的增长，移植中心接受复杂供体的意愿也在增加。虽然存在评估活体肾脏供者的指南，但在评估复杂供者时并没有提供明确的指导。尽管很少有移植中心会批准糖耐量受损的供者候选人，而且大多数（如果不是全部）都会拒绝患有糖尿病的候选人，但许多中心会批准空腹血糖受损（IFG）的候选人。此外，过去 10 年来，活体供者的人群特征发生了变化，越来越多的非白人和西班牙裔个体，他们未来患糖尿病和高血压的风险更高。IFG 可能更令人担忧的是那些非白人和西班牙裔的潜在供者，他们的种族已经使他们处于更高的风险之中。我们回顾了糖尿病的定义、糖尿病预测工具以及与葡萄糖代谢受损相关的供者筛选和排除的移植指南，以及其他需要考虑的种族和非种族因素。我们提供了一个算法，以帮助评估潜在的 IFG 活体供者，其中种族、年龄和代谢综合征的特征在决策中起着重要作用。
