Renal Unit, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, Lancashire, UK.
Nephrol Dial Transplant. 2013 Jul;28(7):1952-60. doi: 10.1093/ndt/gft096. Epub 2013 May 7.
As in most industrialized countries, living kidney donation has increased considerably in the UK and now amounts to 38% of the total UK kidney transplant activity. Living kidney donation guidelines have been formulated by the relevant national societies. We were interested to study whether or not renal units across the UK adhere to those guidelines and to delineate areas of inconsistency and controversy.
Twenty-four adult kidney transplant centres and 50 adult non-transplant renal units across the UK were contacted by a postal questionnaire from January to April 2011.
Twenty-one of 24 (88%) transplanting units and 23 of 50 (46%) non-transplanting units responded. Eighty-one per cent of the responding transplanting units and only 30% of the non-transplanting units have a dedicated live donor clinic. Eighty-six per cent of all units are without a set upper age limit for donors, whereas 7% of units excluded all potential donors older than 70 years. Twenty per cent of units accept donors with body mass indices (BMIs) up to 35, whereas 9% of units did not have an upper limit for BMI. Thirty-two per cent of centres exclude hypertensive donors on more than one antihypertensive drug, whereas 64% of units exclude donors only if they are on more than two anti-hypertensive drugs. of units rely on a spot urine sample to assess proteinuria, while 30% of units still perform 24 h urine collection. Sixty one per cent of units perform computed tomography (CT) angiography to assess the renal vessels prior to donation, while 32% use magnetic resonance (MR) angiography. Seventy-five per cent of centres assess split kidney function by radionuclide testing in all cases, whereas 25% perform this test only if there is a discrepancy in kidney size. The practice of suspension of recipients with potential living donor from the deceased waiting list is also remarkably inconsistent, whereby some centres suspend once a decision for living donation has been made in principle, whereas others suspend the recipient only once a date for surgery has been agreed.
We demonstrate significant variability in accepting living kidney donors, particularly regarding age, BMI, and hypertension. Infrastructure setting for living donation and the live donor assessment are also remarkably inconsistent across the UK. It remains unclear as to why nephrologists decide not to adhere to established guidelines and further research should aim to find the lacking evidence in areas causing inconsistency in living donor assessment.
与大多数工业化国家一样，英国的活体肾脏捐献数量大幅增加，目前占英国肾脏移植总数的 38%。相关国家协会已经制定了活体肾脏捐献指南。我们有兴趣研究英国各地的肾脏单位是否遵守这些指南，并确定不一致和有争议的领域。
2011 年 1 月至 4 月，我们通过邮寄问卷的方式联系了英国的 24 个成人肾脏移植中心和 50 个成人非移植肾脏单位。
24 个移植中心中有 21 个（88%）和 50 个非移植中心中的 23 个（46%）做出了回应。81%的移植中心和只有 30%的非移植中心设有专门的活体供者诊所。86%的单位没有为供者设定固定的年龄上限，而 7%的单位排除了所有 70 岁以上的潜在供者。20%的单位接受体重指数（BMI）高达 35 的供者，而 9%的单位对 BMI 没有上限。32%的中心排除了服用一种以上降压药物的高血压供者，而 64%的中心只排除了服用两种以上降压药物的供者。30%的单位仍然进行 24 小时尿液收集。61%的单位在捐赠前使用计算机断层扫描（CT）血管造影术评估肾脏血管，而 32%的单位使用磁共振（MR）血管造影术。75%的中心在所有情况下都通过放射性核素检查评估分体肾脏功能，而 25%的中心仅在肾脏大小存在差异时进行此检查。对有潜在活体供者的受者从已故等待名单中暂停的做法也存在显著差异，一些中心一旦原则上决定进行活体捐赠就暂停受者，而另一些中心仅在商定手术日期后才暂停受者。
我们发现接受活体肾脏供者的情况存在显著差异，特别是在年龄、BMI 和高血压方面。英国各地活体供肾的基础设施设置和活体供者评估也存在显著差异。目前尚不清楚为什么肾病学家决定不遵守既定的指南，进一步的研究应该旨在找到导致活体供者评估不一致的领域缺乏的证据。
