Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL.
Department of Health Policy and Management, Indiana University-Purdue University Indianapolis, Indianapolis, IN.
Transplantation. 2019 Jul;103(7):1450-1456. doi: 10.1097/TP.0000000000002508.
Living kidney donors in the United States who were obese at donation are at increased risk of end-stage renal disease and may benefit from intensive postdonation follow-up. However, they are less likely to have complete follow-up data. Center variation and risk factors for incomplete follow-up are unknown.
Adult living kidney donors with obesity (body mass index, ≥30 kg/m) at donation reported to the Scientific Registry of Transplant Recipients from January 2005 to July 2015 were included (n = 13 831). Donor characteristics were compared by recorded serum creatinine at 6 months postdonation, and multilevel logistic regression models were used to estimate odds of 6-month creatinine.
After adjustment, older age, female sex, and donation after implementation of new center follow-up requirements were associated with higher odds of 6-month creatinine, with lower odds for obese donors with a history of smoking, biologically related donors, and at centers with higher total living donor volume. 23% of variation in recorded 6-month serum creatinine among obese donors was attributed to center (intraclass correlation coefficient: 0.232, P < 0.001). The adjusted probability of 6-month creatinine by center ranged from 10% to 91.5%.
Tremendous variation in recorded 6-month postdonation serum creatinine exists among obese living donors, with high volume centers having the lowest probability of follow-up. Moreover, individual-level characteristics such as age, sex, and relationship to recipient were associated with recorded 6-month creatinine. Given increased risk for end-stage renal disease among obese living donors, center-level efforts targeted specifically at increasing postdonation follow-up among obese donors should be developed and implemented.
在美国，捐赠时肥胖的活体肾脏捐献者患终末期肾病的风险增加，并且可能受益于捐赠后的强化随访。然而，他们获得完整随访数据的可能性较小。中心间差异以及随访不完整的风险因素尚不清楚。
本研究纳入了自 2005 年 1 月至 2015 年 7 月向移植受者科学注册处报告的捐赠时肥胖（体重指数≥30kg/m）的成年活体肾脏捐献者（n=13831）。根据捐赠后 6 个月的血清肌酐记录，比较了供者特征，使用多水平逻辑回归模型估计了 6 个月时肌酐的比值比。
调整后，年龄较大、女性、以及新中心随访要求实施后的捐赠与 6 个月时肌酐升高的比值比更高，而有吸烟史、生物学相关供者以及总活体供者数量较高的中心的肥胖供者比值比更低。肥胖供者记录的 6 个月血清肌酐的 23%变异归因于中心（组内相关系数：0.232，P＜0.001）。中心间 6 个月血清肌酐的调整后概率范围为 10%至 91.5%。
肥胖活体供者记录的 6 个月捐赠后血清肌酐存在巨大差异，高容量中心的随访概率最低。此外，年龄、性别和与受者的关系等个体特征与记录的 6 个月肌酐有关。鉴于肥胖活体供者发生终末期肾病的风险增加，应制定并实施针对肥胖供者的中心层面的措施，以增加捐赠后的随访。
