Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada.
Institute for Clinical Evaluative Sciences, Kidney, Dialysis & Transplantation, Ontario, Canada.
Transplantation. 2018 Jul;102(7):e345-e353. doi: 10.1097/TP.0000000000002159.
Preemptive kidney transplants result in better outcomes and patient experiences than transplantation after dialysis onset. It is unknown how often a person initiates maintenance dialysis before living kidney donor transplantation when their donor candidate evaluation is well underway.
Using healthcare databases, we retrospectively studied 478 living donor kidney transplants from 2004 to 2014 across 5 transplant centers in Ontario, Canada, where the recipients were not receiving dialysis when their donor's evaluation was well underway. We also explored some factors associated with a higher likelihood of dialysis initiation before transplant.
A total of 167 (35%) of 478 persons with kidney failure initiated dialysis in a median of 9.7 months (25th-75th percentile, 5.4-18.7 months) after their donor candidate began their evaluation and received dialysis for a median of 8.8 months (3.6-16.9 months) before kidney transplantation. The total cohort's dialysis cost was CAD $8.1 million, and 44 (26%) of 167 recipients initiated their dialysis urgently in hospital. The median total donor evaluation time (time from evaluation start to donation) was 10.6 months (6.4-21.6 months) for preemptive transplants and 22.4 months (13.1-38.7 months) for donors whose recipients started dialysis before transplant. Recipients were more likely to start dialysis if their donor was female, nonwhite, lived in a lower-income neighborhood, and if the transplant center received the recipient referral later.
One third of persons initiated dialysis before receiving their living kidney donor transplant, despite their donor's evaluation being well underway. Future studies should consider whether some of these events can be prevented by addressing inappropriate delays to improve patient outcomes and reduce healthcare costs.
抢先进行肾脏移植会比透析后进行移植带来更好的结果和患者体验。目前尚不清楚在供体候选人评估进展顺利的情况下，一个人在接受活体供肾移植前开始维持性透析的频率。
我们使用医疗保健数据库，回顾性地研究了 2004 年至 2014 年间在加拿大安大略省的 5 个移植中心进行的 478 例活体供肾移植，这些受者在供者评估进展顺利时并未接受透析。我们还探讨了一些与移植前更有可能开始透析相关的因素。
共有 478 例肾衰竭患者中有 167 例（35%）在其供体候选人开始评估后的中位数 9.7 个月（25%至 75%分位数为 5.4 至 18.7 个月）开始透析，并在接受透析中位数 8.8 个月（3.6 至 16.9 个月）后进行了肾移植。整个队列的透析费用为 810 万加元，44 例（26%）的 167 例受者紧急在医院开始透析。抢先移植的供体总评估时间（从评估开始到捐赠的时间）中位数为 10.6 个月（6.4 至 21.6 个月），而供体的受者在移植前开始透析的评估时间中位数为 22.4 个月（13.1 至 38.7 个月）。如果供体是女性、非白人、居住在低收入社区，或者移植中心较晚收到受者的转诊，那么受者更有可能开始透析。
尽管供体的评估进展顺利，但仍有三分之一的人在接受活体供肾移植前开始透析。未来的研究应考虑是否可以通过解决不适当的延迟来预防其中一些事件，以改善患者的结局并降低医疗保健成本。
