Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland.
Am J Transplant. 2019 Sep;19(9):2614-2621. doi: 10.1111/ajt.15368. Epub 2019 May 3.
The number of live kidney donors has declined since 2005. This decline parallels the evolving knowledge of risk for biologically related, black, and younger donors. To responsibly promote donation, we sought to identify declining low-risk donor subgroups that might serve as targets for future interventions. We analyzed a national registry of 77 427 donors and quantified the change in number of donors per 5-year increment from 2005 to 2017 using Poisson regression stratified by donor-recipient relationship and race/ethnicity. Among related donors aged <35, 35 to 49, and ≥50 years, white donors declined by 21%, 29%, and 3%; black donors declined by 30%, 31%, and 12%; Hispanic donors aged <35 and 35 to 49 years declined by 18% and 15%, and those aged ≥50 increased by 10%. Conversely, among unrelated donors aged <35, 35 to 49, and ≥50 years, white donors increased by 12%, 4%, and 24%; black donors aged <35 and 35 to 49 years did not change but those aged ≥50 years increased by 34%; Hispanic donors increased by 16%, 21%, and 46%. Unlike unrelated donors, related donors were less likely to donate in recent years across race/ethnicity. Although this decline might be understandable for related younger donors, it is less understandable for lower-risk related older donors (≥50 years). Biologically related older individuals are potential targets for interventions to promote donation.
自 2005 年以来，活体肾脏捐献者的数量有所下降。这种下降与人们对生物相关的、黑人以及年轻捐献者的风险认知的不断发展是一致的。为了负责任地推动捐献，我们试图确定可能成为未来干预目标的低风险捐献者亚组。我们分析了一个包含 77427 名捐献者的全国登记处，使用泊松回归按供受者关系和种族/民族分层，量化了从 2005 年到 2017 年每 5 年增加的捐献者数量的变化。在年龄<35 岁、35 至 49 岁和≥50 岁的相关供者中，白人供者下降了 21%、29%和 3%；黑人供者下降了 30%、31%和 12%；年龄<35 岁和 35 至 49 岁的西班牙裔供者下降了 18%和 15%，而≥50 岁的供者则增加了 10%。相反，在年龄<35 岁、35 至 49 岁和≥50 岁的非相关供者中，白人供者增加了 12%、4%和 24%；年龄<35 岁和 35 至 49 岁的黑人供者没有变化，但≥50 岁的黑人供者增加了 34%；西班牙裔供者增加了 16%、21%和 46%。与非相关供者不同，近年来，不同种族/民族的相关供者捐献的可能性较小。虽然这种下降对于相关的年轻供者来说是可以理解的，但对于风险较低的相关老年供者（≥50 岁）来说就不太理解了。生物相关的老年个体是促进捐献的干预措施的潜在目标。
