Department of Nephrology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Centre de recherche sur l'inflammation, INSERM UMR1149, CNRS EL8252, Laboratoire d'Excellence Inflamex, Université de Paris, Paris, France.
Nephrology and Renal Transplantation Department, CHU Nantes, Nantes, France.
Transpl Int. 2021 Jun;34(6):1123-1133. doi: 10.1111/tri.13870. Epub 2021 May 20.
Multiple days assessments are frequent for the evaluation of candidates to living kidney donation, combined with an early GFR estimation (eGFR). Living kidney donation is questionable when eGFR is <90 ml/min/1.73 m (KDIGO guidelines) or 80 ml/min/1.73 m (most US centres). However, age-related GFR decline results in a lower eGFR for older candidates. That may limit the number of older kidney donors. Yet, continuing the screening with a GFR measure increases the number of eligible donors. We hypothesized that in-depth screening should be proposed to all candidates with a normal eGFR for age. We compared the evolution of eGFR after donation between three groups of predonation eGFR: normal for age (S ) higher than 90 or 80 ml/min/1.73 m (S and S respectively); across three age groups (<45, 45-55, >55 years) in a population of 1825 French living kidney donors with a median follow-up of 5.9 years. In donors younger than 45, postdonation eGFR, absolute- and relative-eGFR variation were not different between the three groups. For older donors, postdonation eGFR was higher in S than in S or S but other comparators were identical. Postdonation eGFR slope was comparable between all groups. Our results are in favour of in-depth screening for all candidates to donation with a normal eGFR for age.
对活体肾脏捐献候选者的评估通常需要进行多天的检查，并结合早期肾小球滤过率估计值（eGFR）。当 eGFR<90ml/min/1.73m（KDIGO 指南）或 80ml/min/1.73m（大多数美国中心）时，活体肾脏捐献是有问题的。然而，与年龄相关的 GFR 下降会导致年龄较大的候选者的 eGFR 降低。这可能会限制老年肾脏供体的数量。然而，通过 GFR 测量继续进行筛选会增加合格供体的数量。我们假设应该向所有 eGFR 正常的年龄相关候选者提出深入的筛选。我们比较了在 1825 名法国活体肾脏捐献者中，三个预捐肾 eGFR 组（S 为年龄正常，高于 90 或 80ml/min/1.73m（S 和 S 分别）；在三个年龄组（<45、45-55、>55 岁）中，在中位随访 5.9 年后，eGFR 在捐肾后的演变情况。在 45 岁以下的供体中，S 组的捐肾后 eGFR、绝对和相对 eGFR 变化与 S 或 S 组之间没有差异。对于年龄较大的供体，S 组的捐肾后 eGFR 高于 S 或 S 组，但其他比较组则相同。所有组之间的捐肾后 eGFR 斜率相似。我们的研究结果支持对所有年龄相关的 eGFR 正常的捐肾候选者进行深入的筛选。
