Masaki N, Iwadoh K, Kondo A, Koyama I, Nakajima I, Fuchinoue S
Department of Surgery III, Tokyo Women's Medical University, Tokyo, Japan.
Department of Surgery III, Tokyo Women's Medical University, Tokyo, Japan.
Transplant Proc. 2018 May;50(4):978-981. doi: 10.1016/j.transproceed.2018.02.052.
Even if a living donor candidate exists, there are some cases that do not result in kidney transplantation (KTx) due to problems on the recipient side. The aim of this study was to clarify causes of ineligibility for KTx in these cases, so as to make RTx more applicable for patients.
We targeted 470 patients with end-stage renal disease who applied for the primary kidney KTx from 2010 to 2012. Then we selected those who were not applicable for KTx and investigated recipient causes of ineligibility for KTx or not receiving KTx.
The average age of recipients was 47.6 ± 12.9 (7-82) years. A majority of the 470 patients were male (n = 305, 64.9%). Two hundred ninety-seven patients intended to receive a living donor KTx and the others hoped for a deceased donor KTx. Of the 297 patients, 207 (70.0%) underwent KTx and 9 (1.9%) were being prepared for KTx at the time of the survey. Eighty-three patients (27.9%) did not receive a living KTx, with 59 of these due to recipient-related problems and 30 due to donor-related problems. We further classified the reasons for these 59 recipients not undergoing KTx as follows: (1) unclear reasons (35.6%); (2) insufficient intention to receive transplant (13.6%); (3) heart disease (10.2%); (4) malignancy (8.5%); (5) immunologic risks (5.1%); (6) death during the waiting period (5.1%); (7) cerebrovascular events (5.1%); (8) cardiovascular problems (5.1%); (9) psychiatric disorders (3.4%); and (10) infections (3.4%).
Nearly 50% of the reasons for ineligibility as a recipient were related to their intention to receive KTx, with 94.9% of the nontransplanted cases due to nonimmunologic reasons. Thanks to the recent advances in immunosuppressive therapy, there were only 3 patients who could not undergo KTx due to immunologic risks. Based on these results, transplant surgeons should not only emphasize physical evaluation but should also pay careful attention to the recipient's intention to receive KTx.
即使存在活体供肾候选人，由于受者方面的问题，仍有一些病例无法进行肾移植（KTx）。本研究的目的是明确这些病例中KTx不适用的原因，以使肾移植（RTx）更适用于患者。
我们选取了2010年至2012年申请初次肾KTx的470例终末期肾病患者。然后我们挑选出那些不适合进行KTx的患者，并调查KTx不适用或未接受KTx的受者原因。
受者的平均年龄为47.6±12.9（7 - 82）岁。470例患者中大多数为男性（n = 305，64.9%）。297例患者打算接受活体供肾KTx，其余患者希望接受尸体供肾KTx。在这297例患者中，207例（70.0%）接受了KTx，9例（1.9%）在调查时正在准备进行KTx。83例患者（27.9%）未接受活体KTx，其中59例是由于受者相关问题，30例是由于供者相关问题。我们将这59例未接受KTx的受者的原因进一步分类如下：（1）原因不明（35.6%）；（2）接受移植的意愿不足（13.6%）；（3）心脏病（10.2%）；（4）恶性肿瘤（8.5%）；（5）免疫风险（5.1%）；（6）等待期间死亡（5.1%）；（7）脑血管事件（5.1%）；（8）心血管问题（5.1%）；（9）精神障碍（3.4%）；（10）感染（3.4%）。
近50%的受者不符合条件的原因与他们接受KTx的意愿有关，94.9%的未移植病例是由于非免疫原因。由于免疫抑制治疗的最新进展，只有3例患者因免疫风险无法进行KTx。基于这些结果，移植外科医生不仅应强调身体评估，还应密切关注受者接受KTx的意愿。
