Division of Nephrology, Department of Medicine and the Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO 63104, USA.
Adv Chronic Kidney Dis. 2012 Jul;19(4):220-8. doi: 10.1053/j.ackd.2011.09.005.
Living donors supply approximately 40% of renal allografts in the United States. Based on current data, perioperative mortality after donor nephrectomy is approximately 3 per 10,000 cases, and major and minor perioperative complications affect approximately 3% to 6% and 22% of donors, respectively. Donor nephrectomy does not appear to increase long-term mortality compared with controls, nor does it appear to increase ESRD risk among white donors. Within the donor population, the likelihood of postdonation chronic renal failure and medical comorbidities such as hypertension and diabetes appears to be relatively higher among some donor subgroups, such as African Americans and obese donors, but the impact of uninephrectomy on the lifetime risks of adverse events expected without nephrectomy in these subgroups has not yet been defined. As national follow-up of living donors in the United States is limited in scope, duration, and completeness, additional methods for quantifying risk among diverse living donors are needed. In addition to improved national collection of follow-up data, possible sources of information on donor outcomes may include focused studies with carefully defined control groups, and database integration projects that link national donor registration records to other data sources. Given the growth and evolving characteristics of the living donor population, as well as changes in surgical techniques, tracking of short- and long-term risks after living kidney donation is vital to support truly informed consent and to maintain public trust in living donation. The transplant community must persist in their efforts to accurately assess risk across demographically diverse living kidney donors.
活体供者提供了大约 40%的美国肾移植器官。根据目前的数据，活体供肾切除术后围手术期死亡率约为每 10000 例 3 例，主要和次要围手术期并发症分别影响大约 3%至 6%和 22%的供者。与对照组相比，活体供肾切除术似乎不会增加长期死亡率，也不会增加白种供者的终末期肾病风险。在供者人群中，一些供者亚组（如非裔美国人和肥胖供者）在接受供肾后发生慢性肾衰竭和高血压、糖尿病等医疗合并症的可能性似乎相对较高，但单侧肾切除术对这些亚组中无肾切除术预期的不良事件终生风险的影响尚未确定。由于美国对活体供者的全国性随访在范围、持续时间和完整性方面都受到限制，因此需要其他方法来量化不同活体供者的风险。除了改进全国范围内的随访数据收集之外，可能有助于获取供者结局信息的来源还包括：有精心定义对照组的重点研究，以及将全国供者登记记录与其他数据源相链接的数据库集成项目。鉴于活体供者人群的增长和不断变化的特征，以及手术技术的变化，跟踪活体捐献肾脏后的短期和长期风险对于支持真正的知情同意和维护公众对活体捐献的信任至关重要。移植界必须坚持不懈地努力，准确评估不同人口统计学背景的活体肾脏供者的风险。
