University of Wisconsin School of Medicine and Public Health, Madison, WI.
University of Pennsylvania Perelman School of Medicine, Philadelphia, PA.
Am J Kidney Dis. 2020 Mar;75(3):299-316. doi: 10.1053/j.ajkd.2019.10.005. Epub 2020 Jan 29.
Living kidney donation is widely practiced throughout the world. During the past 2 decades, various groups have provided guidance about the evaluation and care of living donors. However, during this time, our knowledge in the field has advanced substantially and many agreed on the need for a comprehensive, unifying document. KDIGO (Kidney Disease: Improving Global Outcomes) addressed this issue at an international level with the publication of its clinical practice guideline on the evaluation and care of living kidney donors. The KDIGO work group extensively reviewed the available literature and wrote a series of guideline recommendations using various degrees of evidence when available. As has become recent practice, NKF-KDOQI (National Kidney Foundation-Kidney Disease Outcomes Quality Initiative) convened a work group to provide a commentary on the KDIGO guideline, with a focus on how these recommendations apply in the context of the United States. In the United States, the United Network for Organ Sharing (UNOS) guides and regulates the practice of living kidney donation. While the KDIGO guideline for the care of living kidney donors and UNOS policy are similar in most aspects of the care of living kidney donors, several important areas are not consistent or do not align with common practice by US transplantation programs in areas in which UNOS has not set specific policy. For the time being, and recognizing the value of the KDIGO guidelines, US transplantation programs should continue to follow UNOS policy.
活体肾脏捐献在全球范围内广泛开展。在过去的 20 年中,不同团体已经提供了有关活体供者评估和护理的指导意见。然而,在此期间,我们在该领域的知识已经取得了实质性的进步,并且许多人都认为需要一份全面、统一的文件。KDIGO(肾脏病:改善全球结局)在国际层面上解决了这个问题,发布了其关于活体肾脏供者评估和护理的临床实践指南。KDIGO 工作组广泛审查了现有文献,并根据现有证据的不同程度撰写了一系列指南建议。正如最近的惯例,NKF-KDOQI(美国国家肾脏基金会-肾脏病结局质量倡议)召集了一个工作组,对 KDIGO 指南进行评论,重点关注这些建议在美国背景下的应用。在美国,器官共享联合网络(UNOS)指导和规范活体肾脏捐献的实践。虽然 KDIGO 活体肾脏供者护理指南和 UNOS 政策在活体肾脏供者护理的大多数方面相似,但在 UNOS 没有制定特定政策的几个重要领域,两者并不一致或不符合美国移植项目的常规做法。目前,鉴于 KDIGO 指南的价值,美国移植项目应继续遵循 UNOS 政策。