Cheng Xingxing S, Glassock Richard J, Lentine Krista L, Chertow Glenn M, Tan Jane C
Division of Nephrology, Department of Medicine, Stanford University, 750 Welch Road, Suite 200, Mail code 5785, Palo Alto, CA 94304 USA.
Department of Medicine, David Geffen School of Medicine at UCLA, Los Angeles, CA USA.
Curr Transplant Rep. 2017;4(4):320-326. doi: 10.1007/s40472-017-0171-8. Epub 2017 Nov 4.
The risks following living kidney donation has been the subject of rigorous investigation in the past several decades. How to utilize the burgeoning new knowledge base to better the risk assessment, education, and health maintenance of donors is unclear. We review the physiologic and epidemiologic evidences on the post-donation state and submit a multiple-hit hypothesis to reconcile the finite elevation in risk of kidney disease after donation with the benign course of most kidney donors.
The risk of end-stage kidney disease is higher in kidney donors compared to similarly healthy non-kidney donors. Nonetheless, post-donation kidney disease is uncommon and arises mostly in the setting of other "hits"-either a "first hit" present at birth or a "second hit" acquired later in life.
The transplant community's focus should be directed toward (1) personalized risk assessment to inform consent before donation and (2) preventing and treating development of "second hits" following kidney donation.
在过去几十年中，活体肾捐赠后的风险一直是严格研究的主题。如何利用迅速增长的新知识基础来改善捐赠者的风险评估、教育和健康维护尚不清楚。我们回顾了关于捐赠后状态的生理学和流行病学证据，并提出一种多重打击假说，以调和捐赠后肾病风险的有限升高与大多数肾捐赠者的良性病程之间的矛盾。
与健康状况相似的非肾捐赠者相比，肾捐赠者患终末期肾病的风险更高。尽管如此，捐赠后肾病并不常见，且大多发生在存在其他“打击”的情况下——要么是出生时就存在的“首次打击”，要么是生命后期获得的“第二次打击”。
移植界的重点应转向：（1）进行个性化风险评估，以便在捐赠前告知相关情况并取得同意；（2）预防和治疗肾捐赠后“第二次打击”的发生。
