Venkataraman Sandheep, Kendrick Jessica
University of Colorado Anschutz Medical Campus, Aurora, CO, USA.
Semin Dial. 2020 Nov;33(6):523-532. doi: 10.1111/sdi.12921. Epub 2020 Oct 4.
Kidney transplantation is the ideal treatment option for patients with end-stage kidney disease (ESKD). Since there is clear mortality benefit to receiving a transplant regardless of comorbidities and age, the gold standard of care should focus on attaining kidney transplantation and minimizing, or better yet eliminating, time on dialysis. Unfortunately, only a small percentage of patients with ESKD receive a kidney transplant. Several barriers to kidney transplantation have been identified. Barriers can largely be grouped into three categories: patient-related, physician/provider-related, and system-related. Several barriers fall into multiple categories and play a role at various levels within the healthcare system. Acknowledging and understanding these barriers will allow transplant centers and dialysis facilities to make the necessary interventions to mitigate these disparities, optimize the transplant evaluation process, and improve patient outcomes. This review will discuss these barriers and potential interventions to increase access to kidney transplantation.
肾移植是终末期肾病（ESKD）患者的理想治疗选择。由于无论合并症和年龄如何，接受移植都有明确的死亡率益处，护理的金标准应侧重于实现肾移植，并尽量减少或更好地消除透析时间。不幸的是，只有一小部分ESKD患者接受了肾移植。已经确定了肾移植的几个障碍。障碍大致可分为三类：患者相关、医生/提供者相关和系统相关。一些障碍属于多个类别，并在医疗保健系统的各个层面发挥作用。认识和理解这些障碍将使移植中心和透析设施能够采取必要的干预措施，以减轻这些差异，优化移植评估过程，并改善患者的治疗效果。本综述将讨论这些障碍以及增加肾移植可及性的潜在干预措施。
