Lentine Krista L, Kasiske Bertram L, Levey Andrew S, Adams Patricia L, Alberú Josefina, Bakr Mohamed A, Gallon Lorenzo, Garvey Catherine A, Guleria Sandeep, Li Philip Kam-Tao, Segev Dorry L, Taler Sandra J, Tanabe Kazunari, Wright Linda, Zeier Martin G, Cheung Michael, Garg Amit X
1 Saint Louis University School of Medicine, St. Louis, MO. 2 Hennepin County Medical Center, Minneapolis, MN. 3 Tufts Medical Center, Boston, MA. 4 Wake Forest School of Medicine, Winston-Salem, NC. 5 Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico. 6 Mansoura University Mansoura, Egypt. 7 Northwestern University, Chicago, IL. 8 University of Minnesota, Minneapolis, MN. 9 Indraprastha Apollo Hospitals, New Delhi, India. 10 Chinese University of Hong Kong, Hong Kong, China. 11 Johns Hopkins University, School of Medicine, Baltimore, MD. 12 Mayo Clinic, Rochester, MN. 13 Tokyo Women's Medical University, Tokyo, Japan. 14 University of Toronto, Toronto, Canada. 15 University Hospital Heidelberg, Heidelberg, Germany. 16 KDIGO, Brussels, Belgium. 17 Western University London, Canada.
Transplantation. 2017 Aug;101(8S Suppl 1):S1-S109. doi: 10.1097/TP.0000000000001769.
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
《2017年改善全球肾脏病预后（KDIGO）活体肾供体评估与管理临床实践指南》旨在帮助评估活体肾供体候选者并在捐献前、捐献期间及捐献后提供管理的医学专业人员。该指南制定过程遵循推荐分级评估、制定与评价（GRADE）方法，指南推荐基于对相关研究的系统评价，其中包括对证据质量和推荐强度的严格评估。然而，许多证据审查小组未找到证据或未进行系统证据检索的推荐，是以未分级的专家意见推荐形式发布的。指南工作组得出结论，全面的风险评估方法应取代基于单一风险因素孤立评估所做的决策。进行了原始数据分析，以生成一个肾衰竭的“概念验证”风险预测模型，以支持供体候选者评估中的定量风险评估框架及合理的共同决策制定。该框架基于同时考虑每位候选者的人口统计学和健康特征概况。文中介绍了供体候选者评估的流程和框架，以及捐献前、捐献期间及捐献后最佳管理的推荐。讨论了证据的局限性，尤其是缺乏确定性的前瞻性研究和临床结局试验。还提供了未来研究的建议，包括持续完善长期风险预测及估计捐献归因风险的新方法的必要性。引用本文献时，请使用以下格式：改善全球肾脏病预后（KDIGO）活体肾供体工作组。KDIGO活体肾供体评估与管理临床实践指南。移植。2017；101（增刊8S）：S1 - S109。
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