Department of Nephrology and Transplantation, Prince of Wales Hospital, Sydney, NSW, Australia.
Clinical School, University of New South Wales, Sydney, NSW, Australia.
Transpl Int. 2019 Mar;32(3):291-299. doi: 10.1111/tri.13366. Epub 2018 Nov 8.
Baseline predonation estimated GFR (eGFR) appears to predict the risk of postdonation chronic kidney disease in live donors. New KIDGO guidelines recommend an eGFR ≥90 ml/min/1.73 m as an acceptable level of glomerular filtration rate (GFR) for kidney donation. In the Australian Paired Kidney Exchange (AKX) program, all donors with a raw measured GFR (mGFR) ≥80 ml/min are deemed suitable for donation, but the significance of this selection indicator is unclear. We analysed the first 129 live donors in the AKX program with at least 1-year follow-up linking records in the AKX database and ANZDATA. There were 73 male and 56 female donors; mean (±SD) age was 53 ± 11 years. Predonation eGFR was 94 ± 13 ml/min/1.73 m , mGFR 99 ± 17 ml/min/1.73 m and raw mGFR 108 ± 18 ml/min. Baseline eGFR was <80 ml/min/1.73 m in 19 donors, and <90 ml/min/1.73 m in 42 donors. At 1 year postdonation eGFR was 68 ± 15 ml/min/1.73 m and the predicted eGFR at 30 years postdonation was on average 50 (29-83) ml/min/1.73 m . The hypothetical mean age at end-stage kidney disease was estimated to be 145 (95% CI 120-263) years. Over 30% of AKX live donors would have been excluded from donation using KDIGO guidelines. Using AKX donor guidelines, the majority of donors with predicted eGFR <30 ml/min/1.73 m 30-year postdonation were aged ≥50 years. Long-term outcome data on AKX donors with low eGFR will need careful monitoring.
基线预捐估计肾小球滤过率（eGFR）似乎可以预测活体供者捐肾后的慢性肾脏病风险。新的 KIDGO 指南建议，eGFR≥90ml/min/1.73m 作为可接受的肾小球滤过率（GFR）水平用于捐肾。在澳大利亚配对肾交换（AKX）计划中，所有 raw 测量肾小球滤过率（mGFR）≥80ml/min 的供者都被认为适合捐肾，但这种选择指标的意义尚不清楚。我们分析了 AKX 计划中前 129 名至少有 1 年随访记录的活体供者，这些记录与 AKX 数据库和 ANZDATA 相关联。其中有 73 名男性和 56 名女性供者；平均（±SD）年龄为 53±11 岁。预捐时的 eGFR 为 94±13ml/min/1.73m，mGFR 为 99±17ml/min/1.73m，raw mGFR 为 108±18ml/min。19 名供者的基线 eGFR＜80ml/min/1.73m，42 名供者的基线 eGFR＜90ml/min/1.73m。捐肾 1 年后的 eGFR 为 68±15ml/min/1.73m，预测 30 年后的 eGFR 平均为 50（29-83）ml/min/1.73m。预计终末期肾病的平均年龄为 145（95%CI 120-263）岁。如果使用 KDIGO 指南，超过 30%的 AKX 活体供者将被排除在捐肾之外。使用 AKX 供者指南，大多数预测 eGFR＜30ml/min/1.73m 30 年后的供者年龄≥50 岁。需要对 AKX 低 eGFR 供者的长期预后数据进行仔细监测。
