终末期肾病个体化风险对活体肾供者选择的影响。

Impact of the individualized risks of end-stage renal disease on living kidney donor selection.

机构信息

Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.

Immuno ConcEpT, CNRS UMR 5164, Bordeaux University, Bordeaux, France.

出版信息

Nephrol Dial Transplant. 2018 Dec 1;33(12):2245-2252. doi: 10.1093/ndt/gfy145.

DOI:10.1093/ndt/gfy145

PMID:29846692

Abstract

BACKGROUND

It is recommended to determine the risks of end-stage renal disease (ESRD) in living donor candidates. The aim of this study was to determine how many candidates would have been cleared for donation according to different thresholds of risks.

METHODS

Four pre-donation and post-donation risks of ESRD were calculated retrospectively using online tools (http://www.transplantmodels.com/) and the calculator of the University of Minnesota for 151 living kidney donors and 27 patients disqualified for living donation based on a glomerular filtration rate (GFR) <80 mL/min/1.73 m2.

RESULTS

A complete overlap of the pre-donation 15-year ESRD risk, pre-donation projected lifetime ESRD risk, post-donation 15-year ESRD risk and the Minnesota post-donation 15-year risk of ESRD or GFR <30 mL/min/1.73 m2 was observed for the living kidney donors and the disqualified candidates. We next defined different thresholds of pre- and post-donation risks of ESRD that could be used for clearing living donation. In candidates over 61 years of age, the use of a pre-donation 15-year ESRD risk of 0.25% and/or a post-donation 15-year ESRD risk of 50 per 10 000 would increase the percentage of donors by 28.6% and 26.3%, respectively. Conversely, only 22.3% of donors aged 18-35 years would have been selected by using a pre-donation projected lifetime ESRD risk <0.5%.

CONCLUSIONS

The use of these ESRD risks would significantly modify donor selection by increasing the percentage of donors ≥61 years of age with GFR <80 mL/min/1.73 m2 and by decreasing the percentage of donors aged 18-35 years with a high GFR.

摘要

背景

建议确定活体供者候选者终末期肾病（ESRD）的风险。本研究旨在确定根据不同风险阈值有多少候选者将被清除捐献资格。

方法

使用在线工具（http://www.transplantmodels.com/）和明尼苏达大学的计算器，回顾性地计算了 151 名活体肾脏供者和 27 名因肾小球滤过率（GFR）<80 mL/min/1.73 m2而被取消活体供者资格的患者的 4 种 ESRD 预捐后风险和 post-donation。

结果

活体肾脏供者和不合格候选者的预捐后 15 年 ESRD 风险、预捐后预测终生 ESRD 风险、post-donation 15 年 ESRD 风险和明尼苏达 post-donation 15 年 ESRD 或 GFR <30 mL/min/1.73 m2 存在完全重叠。接下来，我们定义了不同的预捐后 ESRD 风险阈值，可用于清除活体供者资格。在年龄超过 61 岁的候选者中，使用预捐后 15 年 ESRD 风险为 0.25%和/或 post-donation 15 年 ESRD 风险为 50/10000，将分别使供者的百分比增加 28.6%和 26.3%。相反，仅 22.3%的 18-35 岁供者将通过使用预捐后预测终生 ESRD 风险<0.5%来选择。