Department of Quantitative Health Sciences,, ‡Glickman Urological and Kidney Institute, and, §Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio;, †Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, ‖The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Clin J Am Soc Nephrol. 2014 Feb;9(2):355-65. doi: 10.2215/CJN.03820413. Epub 2014 Jan 23.
Living donors represented 43% of United States kidney donors in 2012. Although research suggests minimal long-term consequences of donation, few comprehensive longitudinal studies for this population have been performed. The primary aims of this study were to examine the incidence, risk factors, and causes of rehospitalization following donation.
DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: State Inpatient Databases (SID) compiled by the Agency for Healthcare Research and Quality were used to identify living donors in four different states between 2005 and 2010 (n=4524). Multivariable survival models were used to examine risks for rehospitalization, and patient characteristics were compared with data from the Scientific Registry of Transplant Recipients (SRTR). Outcomes among patients undergoing appendectomy (n=200,274), cholecystectomy (n=255,231), and nephrectomy for nonmetastatic carcinoma (n=1314) were contrasted.
The study population was similar to United States donors (for SRTR and SID, respectively: mean age, 41 and 41 years; African Americans, 12% and 10%; women, 60% and 61%). The 3-year incidence of rehospitalization following donation was 11% for all causes and 9% excluding pregnancy-related hospitalizations. After censoring of models for pregnancy-related rehospitalizations, older age (adjusted hazard ratio [AHR], 1.02 per year; 95% confidence interval [95% CI], 1.01 to 1.03), African American race (AHR, 2.16; 95% CI, 1.54 to 3.03), depression (AHR, 1.88; 95% CI, 1.12 to 3.14), hypothyroidism (AHR, 1.63; 95% CI, 1.06 to 2.49), and longer initial length of stay were related to higher rehospitalization rates among donors. Compared with living donors, adjusted risks for rehospitalizations were greater among patients undergoing appendectomy (AHR, 1.58; 95% CI, 1.42 to 1.75), cholecystectomy (AHR, 2.25; 95% CI, 2.03 to 2.50), and nephrectomy for nonmetastatic carcinoma (AHR, 2.95; 95% CI, 2.58 to 3.37). Risks for rehospitalizations were higher among African Americans than whites in each of the surgical groups.
The SID is a valuable source for evaluating characteristics and outcomes of living kidney donors that are not available in traditional transplant databases. Rehospitalizations following donor nephrectomy are less than seen with other comparable surgical procedures but are relatively higher among donors who are older, are African American, and have select comorbid conditions. The increased risks for rehospitalizations among African Americans are not unique to living donation.
2012 年，活体供肾者在美国肾移植供体中占 43%。尽管研究表明捐赠的长期影响微乎其微，但针对这一人群的全面纵向研究却寥寥无几。本研究的主要目的是探讨捐赠后再住院的发生率、危险因素和原因。
方法、地点、参与者和测量：使用美国医疗保健研究与质量局汇编的州住院患者数据库（SID），在四个不同的州（2005 年至 2010 年）中确定活体供体（n=4524）。使用多变量生存模型来检查再住院的风险，并且将患者特征与移植受者科学注册处（SRTR）的数据进行比较。对接受阑尾切除术（n=200274）、胆囊切除术（n=255231）和非转移性癌肾切除术（n=1314）的患者的结局进行了对比。
研究人群与美国供体相似（分别为 SRTR 和 SID：平均年龄 41 岁和 41 岁；非裔美国人 12%和 10%；女性 60%和 61%）。所有原因导致的捐赠后 3 年再住院率为 11%，不包括妊娠相关住院治疗。在妊娠相关再住院模型的校正后，年龄较大（校正后的危险比[AHR]，每年 1.02；95%置信区间[95%CI]，1.01 至 1.03）、非裔美国人（AHR，2.16；95%CI，1.54 至 3.03）、抑郁症（AHR，1.88；95%CI，1.12 至 3.14）、甲状腺功能减退症（AHR，1.63；95%CI，1.06 至 2.49）和较长的初始住院时间与供体再住院率较高相关。与活体供体相比，阑尾切除术（AHR，1.58；95%CI，1.42 至 1.75）、胆囊切除术（AHR，2.25；95%CI，2.03 至 2.50）和非转移性癌肾切除术（AHR，2.95；95%CI，2.58 至 3.37）的患者再住院风险调整后更高。在每个手术组中，非裔美国人的再住院风险均高于白人。
SID 是评估活体供肾者特征和结局的有价值的资源，这些资源在传统的移植数据库中无法获得。供肾切除术后再住院的情况少于其他类似的手术，但在年龄较大、非裔美国人且存在特定合并症的供体中相对较高。非裔美国人再住院风险增加的情况并非仅存在于活体供肾者中。
