Sydney School of Public Health, The University of Sydney, Sydney, Australia.
Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Transplantation. 2019 Feb;103(2):284-290. doi: 10.1097/TP.0000000000002489.
Evidence about outcomes after living kidney donation is needed both to inform donor acceptance criteria, and to guide the decisions of potential donors and their healthcare providers about donation. However, the scope and heterogeneity of outcomes reported in research and their relevance to decision making is uncertain. To determine the spectrum and consistency of outcomes reported in randomized trials and observational studies in living kidney donors 18 years or older.
Electronic databases were searched for randomized trials and observational studies reporting outcomes in adult living kidney donors published from January 2011 to May 2017. All outcome domains and measurements were extracted, and their frequency and characteristics were evaluated.
Of the 268 eligible studies, 14 (5%) were randomized and 254 (95%) observational. Overall, 136 (51%) studies were short-term (≤1 year follow up) and reported 109 outcome domains, of which 51 (47%) were classified as clinical, 35 (32%) were surrogate, and 23 (21%) were donor-reported. The 5 most commonly reported domains were kidney function (154, 58%), time to discharge (96, 36%), blood loss (85, 32%), operative time (79, 30%) and blood pressure (74, 28%). Quality of life (13%), mortality (16%), end-stage kidney disease (10%) and cardiovascular events (9%) were reported infrequently.
The outcomes of living kidney donation reported in contemporary trials and observational studies are numerous, heterogeneous, and often focused on short-term surgical complications. Consistent reporting of outcomes relevant to decision making is needed to better inform and prepare donors for outcomes after donation.
需要了解活体肾脏捐献后的结果证据，以便为供者接受标准提供信息，并指导潜在供者及其医疗保健提供者关于捐献的决策。然而，研究中报告的结果的范围和异质性及其对决策的相关性尚不确定。旨在确定 18 岁或以上活体肾脏捐献者的随机试验和观察性研究报告的结果的范围和一致性。
检索了从 2011 年 1 月至 2017 年 5 月发表的报告成人活体肾脏捐献者结果的随机试验和观察性研究的电子数据库。提取了所有的结果领域和测量结果，并评估了它们的频率和特征。
在 268 项合格研究中，有 14 项（5%）为随机研究，254 项（95%）为观察性研究。总体而言，136 项（51%）研究为短期（随访时间≤1 年），报告了 109 个结果领域，其中 51 个（47%）为临床结果，35 个（32%）为替代结果，23 个（21%）为供者报告的结果。报告最多的 5 个领域是肾功能（154 项，58%）、出院时间（96 项，36%）、失血量（85 项，32%）、手术时间（79 项，30%）和血压（74 项，28%）。生活质量（13%）、死亡率（16%）、终末期肾病（10%）和心血管事件（9%）报告较少。
当代试验和观察性研究报告的活体肾脏捐献结果众多、异质，且通常集中于短期手术并发症。需要一致报告与决策相关的结果，以便更好地为供者提供信息并为捐献后的结果做好准备。
