Romagnoli J, Salerno M P, Calia R, Bianchi V, Pedroso J A, Spagnoletti G, Citterio F
Renal Transplant Unit, Catholic University, Rome, Italy.
Transplant Proc. 2013 Sep;45(7):2632-4. doi: 10.1016/j.transproceed.2013.08.001.
The evaluation of a potential living kidney donor (LKD) leads to exclusion of at least 50% of candidates. The aim of this study was to analyze the reasons for exclusion of potential LKDs referred to our center.
We retrospectively analyzed historic and clinical data of all potential LKDs who were evaluated over 7 years from January 2005 to March 2012. Data were obtained by review of an electronic database.
Among 79 (50 female, 29 male) candidates, 24 (30.3%) successfully donated, comprising 22 related and 2 unrelated donors. We excluded 45 (56.9%), and 10 (12.6%) are actively undergoing evaluation. Reasons for exclusion were medical (n = 14; 31%), nonmedical (n = 18; 40%), positive cross-match (n = l7.7%), pregnancy (n = 2; 4.4%), and other reasons (n = 3; 6.6%). Of the 14 donors excluded for medical reasons, 75.8% were due to diabetes, cardiovascular disease, hypertension, or obesity and 21.5% to inadequate renal function, malignancy, or liver disease. Of the 18 (40%) excluded for nonmedical reasons, 6 (33.3%) were because the intended recipient received a deceased-donor transplantation before the evaluation could be completed, 5 (27.7%) because the recipient was no longer a candidate for transplantation, 5 (27.7%) because of donor withdrawal, and 2 (11.1%) for other reasons.
Positive cross-match and deceased-donor transplantation during the evaluation process were the 2 most common reasons for LKD exclusion. Evaluation of potential LKDs is time consuming, requiring a remarkable amount of human and material resources. A dedicated pathway for the diagnostic work-up of LKDs may speed- the evaluation process and improve its efficiency, use of ABO-incompatible or paired-exchange donations may increase the yield of donor organs.
对潜在活体肾供者（LKD）的评估会导致至少50%的候选者被排除。本研究的目的是分析转诊至我们中心的潜在LKD被排除的原因。
我们回顾性分析了2005年1月至2012年3月7年间所有接受评估的潜在LKD的历史和临床数据。数据通过查阅电子数据库获得。
在79名候选者（50名女性，29名男性）中，24名（30.3%）成功捐献，包括22名亲属供者和2名非亲属供者。我们排除了45名（56.9%），10名（12.6%）正在接受评估。排除原因包括医学原因（n = 14；31%）、非医学原因（n = 18；40%）、交叉配型阳性（n = 7；17.7%）、妊娠（n = 2；4.4%）和其他原因（n = 3；6.6%）。在因医学原因被排除的14名供者中，75.8%是由于糖尿病、心血管疾病、高血压或肥胖，21.5%是由于肾功能不全、恶性肿瘤或肝脏疾病。在因非医学原因被排除的18名（40%）中，6名（33.3%）是因为预期受者在评估完成前接受了尸体供者移植，5名（27.7%）是因为受者不再是移植候选者，5名（27.7%）是因为供者退出，2名（11.1%）是其他原因。
评估过程中的交叉配型阳性和尸体供者移植是LKD被排除的两个最常见原因。对潜在LKD的评估耗时，需要大量人力和物力。建立专门的LKD诊断检查途径可能会加快评估过程并提高其效率，采用ABO血型不相容或配对交换捐献可能会增加供者器官的数量。
