AlBugami M M, AlOtaibe F E, Boqari D, AlAbadi A M, Hamawi K, Bel'eed-Akkari K
Multi-Organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
Multi-Organ Transplant Center, King Fahad Specialist Hospital, Dammam, Saudi Arabia.
Transplant Proc. 2019 Mar;51(2):504-508. doi: 10.1016/j.transproceed.2019.01.008. Epub 2019 Jan 4.
Living donor kidney transplantation is the best type of renal replacement therapy. However, large numbers of potential living kidney donors (LKDs) are declined because of various reasons. The aim of this study is to define and quantify the reasons for declining potential LKDs.
All potential LKDs evaluated at our center between September 2008 and December 2016 were reviewed. Data were collected from the electronic database.
A total of 2090 potential LKDs were evaluated, with an average age of 32 years (range, 18-67 years) and men constituting 72.6%. A total of 675 (32.3%) were accepted for donor nephrectomy. Living kidney donation did not proceed in 830 (39.7%): 661 (79.6%) because of donor-related reasons and 169 (20.4%) because of recipient-related reasons. Donor-related reasons included medical contraindications (61.7%), immunological barriers (23.1%), surgical contraindications (7.9%), and psychosocial reasons (7.3%). A total of 585 (28.0%) potential LKDs voluntarily withdrew themselves at variable time points during the evaluation process, even after being accepted for donation. Male and young (18-35 years) potential LKDs were more likely to withdraw compared with female and older (>35 years) potential LKDs (34.3% vs 11.4%, P < .005 and 29.6% vs 24.5%, P = .02, respectively).
Despite the large number of potential LKDs, medically complex donors are increasing, and a significant proportion decided to withdraw at some point during the evaluation process. The latter highlights the need to increase public awareness about living donation, to perform more careful initial screening and targeted educational programs, and to provide continuous support for potential LKDs.
活体供肾移植是肾替代治疗的最佳方式。然而，大量潜在的活体肾供者（LKDs）因各种原因被拒绝。本研究的目的是明确并量化拒绝潜在LKDs的原因。
回顾了2008年9月至2016年12月在本中心评估的所有潜在LKDs。数据从电子数据库中收集。
共评估了2090名潜在LKDs，平均年龄32岁（范围18 - 67岁），男性占72.6%。共有675名（32.3%）被接受进行供肾切除术。830名（39.7%）未进行活体肾捐献：661名（79.6%）是由于供者相关原因，169名（20.4%）是由于受者相关原因。供者相关原因包括医学禁忌证（61.7%）、免疫屏障（23.1%）、手术禁忌证（7.9%）和社会心理原因（7.3%）。共有585名（28.0%）潜在LKDs在评估过程中的不同时间点自愿退出，甚至在被接受捐献后也是如此。与女性和年龄较大（>35岁）的潜在LKDs相比，男性和年轻（18 - 35岁）的潜在LKDs更有可能退出（分别为34.3%对11.4%，P <.005；29.6%对24.5%，P =.02）。
尽管有大量潜在LKDs，但医学情况复杂的供者在增加，并且相当一部分在评估过程中的某个时候决定退出。后者凸显了提高公众对活体捐献的认识、进行更仔细的初始筛查和针对性教育项目以及为潜在LKDs提供持续支持的必要性。
