Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, NSW, Australia.
Transplantation. 2012 Oct 15;94(7):703-13. doi: 10.1097/TP.0b013e3182637078.
Apparent variability in wait-listing criteria globally has raised concern about inequitable access to kidney transplantation. This study aimed to compare the quality, the scope, and the consistency of international guidelines on wait-listing for kidney transplantation.
Electronic databases and guideline registries were searched to December 2011. The Appraisal of Guidelines for Research and Evaluation II instrument and textual synthesis was used to assess and compare recommendations.
Fifteen guidelines published from 2001 to 2011 were included. Methodological rigor and scope were variable. We identified 4 major criteria across guidelines: recipient age and life expectancy, medical criteria, social and lifestyle circumstances, and psychosocial considerations. Whereas some recommendations were consistent, there were differences in age cutoffs, estimated life expectancy (2-5 years), and glomerular filtration rate at listing (15-20 mL/min/1.73 m). Cardiovascular contraindications were broadly defined. Recommended cancer-free periods also varied substantially, and whereas uncontrolled infections were universally contraindicated, human immunodeficiency virus thresholds and adherence to highly active antiretroviral therapy were inconsistent. Most guidelines recommended psychological screening but were not augmented with specific clinical assessment tools.
Wait-listing recommendations in current guidelines are based on life expectancy, comorbidities, lifestyle, and psychosocial factors. Some recommendations are different across guidelines or broadly defined. There is a case for developing comprehensive, methodologically robust, and regularly updated guidelines on wait-listing for kidney transplantation.
全球范围内等待名单标准的明显差异引起了人们对肾脏移植公平性的关注。本研究旨在比较国际肾脏移植等待名单标准的质量、范围和一致性。
搜索了截至 2011 年 12 月的电子数据库和指南注册处。使用评估研究和评估指南 II 工具以及文本综合方法来评估和比较建议。
纳入了 2001 年至 2011 年期间发布的 15 项指南。方法学严谨性和范围各不相同。我们确定了指南中的 4 个主要标准：受者年龄和预期寿命、医疗标准、社会和生活方式情况以及心理社会因素。虽然一些建议是一致的，但在年龄截止点、估计预期寿命（2-5 年）和列出时的肾小球滤过率（15-20 mL/min/1.73 m）方面存在差异。心血管禁忌症被广泛定义。推荐的无癌期也有很大差异，虽然未控制的感染普遍被禁止，但人类免疫缺陷病毒的阈值和对高效抗逆转录病毒治疗的依从性不一致。大多数指南建议进行心理筛查，但没有使用特定的临床评估工具进行补充。
当前指南中的等待名单建议基于预期寿命、合并症、生活方式和心理社会因素。一些建议在不同的指南或广泛定义中有所不同。有必要制定全面、方法严谨且定期更新的肾脏移植等待名单指南。
