UCSD Center for Transplantation and Division of Nephrology, University of California at San Diego School of Medicine, San Diego, CA, USA.
Am J Transplant. 2019 Jan;19(1):32-36. doi: 10.1111/ajt.15089. Epub 2018 Oct 3.
Short studies that generate lifetime end-stage renal disease (ESRD) risks for young living kidney donors have conflicted with the knowledge and practice of nontransplant specialists. A widely accepted online risk calculator (OLRC) is no exception. It uses 6.4 year observations and an ostensibly empiric methodology to predict low lifetime risks for normal young candidates. But the nonspecific ESRD risk factors identified in this study are likely features of kidney diseases that were already underway at study entry. No practicing nephrologist would use their absence to predict any specific kidney disease that had yet to begin, which is essential for excluding high-risk individuals. The OLRC's risk estimates are particularly low because it also does not assign to young adults about 70% of the lifetime ESRD that they will experience as they age, which is part of their risk. It reinforces traditional concepts of low donor risk, minimizing the potential relevance of recent, sometimes concerning, long-term outcome data. These data suggest many similarities between postdonation ESRD and ESRD in the general population, about which much is already known. Despite our best efforts, the heterogeneity and exponential accumulation of end-stage kidney diseases over time prevent long-term predictions of risk for young kidney donors.
短期研究表明，年轻活体肾脏捐献者会终身面临终末期肾病（ESRD）风险，这与非移植专家的知识和实践相冲突。广受欢迎的在线风险计算器（OLRC）也不例外。它使用 6.4 年的观察结果和表面上的经验方法来预测正常年轻供体的低终身风险。但在这项研究中确定的非特异性 ESRD 风险因素很可能是已经在进行中的肾脏疾病的特征。没有任何执业肾病学家会根据这些因素来预测任何尚未开始的特定肾脏疾病，这对于排除高风险个体至关重要。OLRC 的风险估计特别低，因为它也没有将年轻人一生中约 70%的 ESRD 风险分配给年轻人，而这是他们风险的一部分。它强化了低供体风险的传统观念，最大限度地减少了最近有时令人担忧的长期结果数据的潜在相关性。这些数据表明，捐赠后 ESRD 与普通人群中的 ESRD 之间存在许多相似之处，关于这些问题已经有了很多了解。尽管我们尽了最大努力，但随着时间的推移，终末期肾脏疾病的异质性和指数积累，使得对年轻肾脏捐献者的风险进行长期预测变得不可能。
