Plage Henning, Pielka Poline, Liefeldt Lutz, Budde Klemens, Ebbing Jan, Sugünes Nesrin, Miller Kurt, Cash Hannes, Bichmann Anna, Sattler Arne, Kotsch Katja, Friedersdorff Frank
Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.
Ther Clin Risk Manag. 2020 Aug 24;16:787-793. doi: 10.2147/TCRM.S256962. eCollection 2020.
An expansion of selection criteria for deceased organ transplantation already exists to manage the current donor shortage. Comparable evaluation of risk factors for living donors should be investigated to improve this issue.
Our retrospective single-centre study analysed 158 patients with living kidney transplants performed between February 2006 and June 2012. We investigated the influence of donor risk factors (RF) including body mass index over 30 kg/m, age >60 years, active nicotine abuse and arterial hypertension on postoperative kidney function with focus on the recipients. This was measured for long-term survival and glomerular filtration rate (GFR) in a 5-year follow-up.
Overall, out of 158 living donors, 84 donors were identified to have no risk factors, whereas 74 donors had at least one risk factor. We noted a significant higher delayed graft function (p=0.042) in the first 7 days after transplantation, as well as lower GFR of recipients of allografts with risk factors in the first-year after transplantation. In our long-term results, there was no significant difference in the functional outcome (graft function, recipient and graft survival) between recipients receiving kidneys from donors with no and at least one risk factors. In the adjusted analysis of subgroups of different risk factors, recipients of donors with "age over 60 years" at time of transplantation had a decreased transplant survival (p=0.014).
Thus, a careful expansion for selection criteria for living donors with critical evaluation could be possible, but especially the age of the donors could be a limited risk factor.
为应对当前供体短缺问题，已故器官移植的选择标准已有所扩展。应研究对活体供体风险因素进行可比评估，以改善这一问题。
我们的回顾性单中心研究分析了2006年2月至2012年6月期间进行的158例活体肾移植患者。我们调查了供体风险因素（RF）的影响，包括体重指数超过30kg/m²、年龄>60岁、主动吸烟和动脉高血压对术后肾功能的影响，重点关注受者。在5年随访中对长期存活和肾小球滤过率（GFR）进行了测量。
总体而言，在158名活体供体中，84名供体被确定没有风险因素，而74名供体至少有一个风险因素。我们注意到移植后前7天延迟移植功能显著更高（p=0.042），并且移植后第一年有风险因素的同种异体移植受者的GFR更低。在我们的长期结果中，接受无风险因素供体和至少有一个风险因素供体肾脏的受者在功能结局（移植功能、受者和移植存活）方面没有显著差异。在对不同风险因素亚组的校正分析中，移植时“年龄超过60岁”供体的受者移植存活率降低（p=0.014）。
因此，在进行严格评估的情况下，有可能谨慎扩大活体供体的选择标准，但尤其是供体年龄可能是一个有限的风险因素。
