Department of Surgery, Division of Transplantation, University of Alabama at Birmingham, AL.
Department of Medicine, Division of Transplant Nephrology, University of Alabama at Birmingham, AL.
Surgery. 2019 Nov;166(5):940-946. doi: 10.1016/j.surg.2019.07.008. Epub 2019 Aug 20.
The scarcity of organs available for transplantation has increased attempts to augment transplantation by utilizing obese living kidney donors. The literature has suggested that these donors have increased risks postdonation. Not surprising, the threshold for living kidney donor approval among obese persons is typically higher and the process more costly. Therefore, a screening tool to predict the likelihood of approval among obese living kidney donor candidates was created.
A single-center retrospective study was performed among obese (body mass index ≥ 30 kg/m2) living kidney donor candidates evaluated in clinic (January 1, 2012, to December 31, 2017). Approved candidates were compared with those not approved using multivariable logistic regression, and a prediction tool was generated.
Among 389 obese living kidney donor candidates, there were no significant differences in sex or race and ethnicity by approval status. However, nonapproved candidates had a higher prevalence of metabolic syndrome. In the prediction model, glucose impairment and hypertension were most predictive of nonapproval.
Among obese living kidney donor candidates, several metabolic syndrome components were associated with decreased odds of approval. This tool may serve as a useful initial screening for obese living kidney donor candidates, permitting more cost-effective evaluation processes. The tool could also be used to promote expeditious interventions in the preclinical setting, including weight management programs, to improve the likelihood of donation and postdonation outcomes.
可供移植的器官稀缺，促使人们增加利用肥胖活体肾脏捐献者来增加移植数量的尝试。文献表明，这些捐献者在捐赠后存在更高的风险。毫不奇怪，肥胖者成为活体肾脏捐献者的门槛通常更高，且过程更昂贵。因此，创建了一种预测肥胖活体肾脏捐献者候选者获得批准可能性的筛选工具。
对 2012 年 1 月 1 日至 2017 年 12 月 31 日在诊所评估的肥胖（体重指数≥30kg/m2）活体肾脏捐献者候选者进行了单中心回顾性研究。使用多变量逻辑回归比较获得批准和未获得批准的候选者，并生成预测工具。
在 389 名肥胖活体肾脏捐献者候选者中，按批准状态，在性别或种族和民族方面没有显著差异。然而，未获批准的候选者代谢综合征的患病率更高。在预测模型中，葡萄糖受损和高血压对未获批准的预测最具预测性。
在肥胖活体肾脏捐献者候选者中，几种代谢综合征成分与批准几率降低有关。该工具可用作肥胖活体肾脏捐献者候选者的有用初始筛选，从而实现更具成本效益的评估过程。该工具还可用于促进临床前环境中的快速干预，包括体重管理计划，以提高捐赠和捐赠后结果的可能性。
