Richards Vanessa L, Johnson Christopher K, Perkins James D, Limaye Ajit P, Sibulesky Lena
Division of Nephrology, Department of Medicine, University of Washington Medical Center, Seattle, WA, USA.
Division of Transplant Surgery, Department of Surgery, University of Washington Medical Center, Seattle, WA, USA.
Ann Transplant. 2018 Jun 5;23:387-392. doi: 10.12659/AOT.908660.
BACKGROUND The number of Public Health Service increased-risk organ donors (PHS IRD) is growing, largely from an increase in intravenous drug use overdoses due to the current opioid epidemic. MATERIAL AND METHODS We conducted a retrospective case series review using our single-center data. We reviewed 82 PHS IRD kidney transplant offers between 2015 and 2017, 20 of which were declined. We reviewed outcomes of patients who declined vs. accepted PHS IRD offers. We studied the effect of education on these patients' willingness to consider another PHS IRD. RESULTS Twenty patients declined PHS IRD over a 2-year period. They waited on average 9 months for another transplant, and tended to be transplanted with a higher-KDPI kidney than the one originally offered. Patients who declined PHS IRD were more likely to be predialysis, women, and Asian American, and to require an interpreter. Ninety-two percent of patients who received education on PHS IRD after declining an offer stated that they would consider another PHS IRD offer in the future. Four of these patients received a PHS IRD transplant. CONCLUSIONS Our results suggest that education of patients may have a positive impact on patient attitudes toward PHS IRD.
背景 公共卫生服务增加风险器官捐献者（PHS IRD）的数量正在增加，主要原因是当前阿片类药物流行导致静脉药物使用过量情况增多。
材料与方法 我们使用单中心数据进行了一项回顾性病例系列研究。我们回顾了2015年至2017年间82例PHS IRD肾脏移植提议，其中20例被拒绝。我们比较了拒绝和接受PHS IRD提议的患者的结局。我们研究了教育对这些患者考虑再次接受PHS IRD提议意愿的影响。
结果 在两年时间里有20例患者拒绝了PHS IRD提议。他们平均等待9个月进行另一次移植，并且移植的肾脏的肾脏疾病预后质量倡议（KDPI）往往高于最初提供的肾脏。拒绝PHS IRD提议的患者更有可能处于透析前阶段、为女性、是亚裔美国人，并且需要翻译。92%在拒绝提议后接受了关于PHS IRD教育的患者表示他们未来会考虑再次接受PHS IRD提议。其中4例患者接受了PHS IRD移植。
结论 我们的结果表明，对患者进行教育可能会对患者对PHS IRD的态度产生积极影响。
