University of Bristol, Bristol, United Kingdom (L.M.O.).
University of Cambridge and National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, United Kingdom (A.R.).
Ann Intern Med. 2018 Feb 20;168(4):276-284. doi: 10.7326/M17-1235. Epub 2018 Jan 30.
Long-term health risks for adults who donate kidneys are unclear.
To summarize evidence about mid- and long-term health risks associated with living kidney donation in adults.
PubMed, Embase, Scopus, and PsycINFO without language restriction from April 1964 to July 2017.
Observational studies with at least 1 year of follow-up that compared health outcomes in adult living kidney donors versus nondonor populations.
Two investigators independently extracted study data and assessed study quality.
52 studies, comprising 118 426 living kidney donors and 117 656 nondonors, were included. Average follow-up was 1 to 24 years. No evidence suggested higher risk for all-cause mortality, cardiovascular disease, hypertension, type 2 diabetes, or adverse psychosocial health outcomes in living kidney donors than in nondonor populations. Donors had higher diastolic blood pressure, lower estimated glomerular filtration rates, and higher risk for end-stage renal disease (ESRD) (relative risk [RR], 8.83 [95% CI, 1.02 to 20.93]) and preeclampsia in female donors (RR, 2.12 [CI, 1.06 to 4.27]). Despite the increased RR, donors had low absolute risk for ESRD (incidence rate, 0.5 event [CI, 0.1 to 4.9 events] per 1000 person-years) and preeclampsia (incidence rate, 5.9 events [CI, 2.9 to 8.9 events] per 100 pregnancies).
Generalizability was limited by selected control populations, few studies reported pregnancy-related outcomes, and few studies were from low- and middle-income countries.
Although living kidney donation is associated with higher RRs for ESRD and preeclampsia, the absolute risk for these outcomes remains low. Compared with nondonor populations, living kidney donors have no increased risk for other major chronic diseases, such as type 2 diabetes, or for adverse psychosocial outcomes.
National Health Service Blood and Transplant and National Institute for Health Research. (PROSPERO: CRD42017072284).
长期健康风险对于捐肾的成年人来说并不明确。
总结成人活体肾脏捐献与中、长期健康风险相关的证据。
从 1964 年 4 月到 2017 年 7 月，无语言限制地检索了 PubMed、Embase、Scopus 和 PsycINFO 数据库。
至少随访 1 年，比较成人活体肾脏捐献者与非捐献者人群健康结局的观察性研究。
两名调查员独立提取研究数据并评估研究质量。
纳入了 52 项研究，共包含 118426 名活体肾脏捐献者和 117656 名非捐献者。平均随访时间为 1 至 24 年。没有证据表明与非捐献者人群相比，活体肾脏捐献者的全因死亡率、心血管疾病、高血压、2 型糖尿病或不良的心理健康结局风险更高。与非捐献者人群相比，捐献者的舒张压更高、估算肾小球滤过率更低、终末期肾病（ESRD）风险更高（相对风险[RR]，8.83[95%CI，1.02 至 20.93]）和女性捐献者的子痫前期风险更高（RR，2.12[CI，1.06 至 4.27]）。尽管 RR 增加，但 ESRD（发病率，0.5 例[CI，0.1 至 4.9 例]每 1000 人年）和子痫前期（发病率，5.9 例[CI，2.9 至 8.9 例]每 100 例妊娠）的绝对风险仍然较低。
由于选择了特定的对照人群，研究的代表性有限，很少有研究报告与妊娠相关的结局，而且很少有研究来自中低收入国家。
尽管活体肾脏捐献与 ESRD 和子痫前期的 RR 增加有关，但这些结局的绝对风险仍然较低。与非捐献者人群相比，活体肾脏捐献者没有更高的 2 型糖尿病或其他不良心理健康结局等主要慢性疾病风险。
英国国民保健署血液与移植署和英国国家卫生研究院。（PROSPERO：CRD42017072284）。
