Faculty of Medicine, University of Toronto, Ontario, Canada.
Nephrol Dial Transplant. 2014 Jan;29(1):188-95. doi: 10.1093/ndt/gft239. Epub 2013 Oct 21.
Kidney transplants from living donors with an estimated glomerular filtration rate (eGFR) < 80 mL/min per 1.73 m(2) may be at risk for increased graft loss compared with a recipient who receives a kidney from a living donor with a higher eGFR.
This retrospective cohort study considered 2057 living kidney donors and their recipients from July 1993 to March 2010 at five centres in Ontario, Canada, and linked them to population-based, universal healthcare databases. Recipients were divided into five groups based on their donor's baseline eGFR. The median (inter-quartile range) for the lowest eGFR group was 73 (68-77) mL/min per 1.73 m(2). Subjects were followed for a median of 6 years (IQR: 3-10 years).
There was no significant difference in the adjusted hazard ratio (HR) for graft loss when comparing recipients in each eGFR category to the referent group (≥110 mL/min per 1.73 m(2)). The adjusted HRs (95% CI) from the lowest (<80 mL/min per 1.73 m(2)) to highest (100-109.9 mL/min per 1.73 m(2)) eGFR categories were 1.27 (0.84-1.92), 1.43 (0.96-2.14), 1.23 (0.86-1.77) and 1.23 (0.85-1.77), respectively. Similar results were observed when dichotomizing the baseline donor eGFR using a cut-point of 80 mL/min per 1.73 m(2)-adjusted HR 1.01 [95% confidence interval (95% CI) (0.76-1.44)].
Further research in this setting should clarify whether additional tests (i.e. measured GFR) should be performed in potential donors whose eGFR is considered borderline, whether eGFR values should be standardized to body surface area, and the outcomes for donors after nephrectomy.
与接受来自肾小球滤过率（eGFR）较高的活体供者的肾脏的受者相比，来自 eGFR<80 mL/min/1.73 m²的活体供者的肾脏移植可能存在移植物丢失风险增加的情况。
本回顾性队列研究纳入了 1993 年 7 月至 2010 年 3 月在加拿大安大略省的五个中心的 2057 名活体供者及其受者，并将他们与基于人群的、全民医疗保健数据库相联系。根据供者的基线 eGFR 将受者分为五组。eGFR 最低组的中位数（四分位距）为 73（68-77）mL/min/1.73 m²。中位随访时间为 6 年（四分位距：3-10 年）。
在将每个 eGFR 类别中的受者与参考组（≥110 mL/min/1.73 m²）进行比较时，移植肾丢失的调整后的危险比（HR）无显著差异。最低（<80 mL/min/1.73 m²）至最高（100-109.9 mL/min/1.73 m²）eGFR 类别之间的调整后 HR（95%CI）分别为 1.27（0.84-1.92）、1.43（0.96-2.14）、1.23（0.86-1.77）和 1.23（0.85-1.77）。当使用 80 mL/min/1.73 m² 作为截断值将基线供者 eGFR 二分类化时，观察到了相似的结果-调整后 HR 为 1.01（95%CI（0.76-1.44））。
在这种情况下，应进一步研究是否应在 eGFR 被认为临界的潜在供者中进行额外的检查（即，测量的肾小球滤过率），是否应将 eGFR 值标准化为体表面积，以及肾切除术对供者的影响。
