Kasiske Bertram L, Ahn Yoon Son, Conboy Michael, Dew Mary Amanda, Folken Christian, Levan Macey, Israni Ajay K, Lentine Krista L, Matas Arthur J, Newell Kenneth A, LaPointe Rudow Dianne, Massie Allan B, Musgrove Donald, Snyder Jon J, Taler Sandra J, Wang Jeffrey, Waterman Amy D
Scientific Registry of Transplant Recipients, Hennepin Healthcare Research Institute, Minneapolis, MN.
Department of Medicine, Hennepin Healthcare, Minneapolis, MN.
Transplant Direct. 2021 Apr 22;7(5):e689. doi: 10.1097/TXD.0000000000001143. eCollection 2021 May.
Gaps in our knowledge of long-term outcomes affect decision making for potential living kidney donors.
The Scientific Registry of Transplant Recipients was asked to determine the feasibility of a candidate registry.
Ten living kidney donor programs evaluated 2107 consecutive kidney donor candidates; 2099 of 2107 (99.6%) completed evaluations, 1578 of 2099 (75.2%) had a decision, and 790 of 1578 (50.1%) were approved to donate as of March 12, 2020. By logistic regression, candidates most likely to be approved were married or had attended college or technical school; those least likely to be approved had ≥1 of the following characteristics: Black race, history of cigarette smoking, and higher blood pressure, higher triglycerides, or higher urine albumin-to-creatinine ratios. Reasons for 617 candidates not being approved included medical issues other than chronic kidney disease risk (25.3%), chronic kidney disease risk (18.5%), candidate withdrawal (15.2%), recipient reason (13.6%), anatomical risk to the recipient (10.3%), noneconomic psychosocial (10.3%), economic (0.5%), and other reasons (6.4%).
These results suggest that a comprehensive living donor registry is both feasible and necessary to assess long-term outcomes that may inform decision making for future living donor candidates. There may be socioeconomic barriers to donation that require more granular identification so that active measures can address inequities. Some candidates who did not donate may be suitable controls for discerning the appropriateness of acceptance decisions and the long-term outcomes attributable to donation. We anticipate that these issues will be better identified with modifications to the data collection and expansion of the registry to all centers over the next several years.
我们对长期结果认知的空白影响了潜在活体肾供体的决策。
要求移植受者科学注册中心确定候选者注册的可行性。
10个活体肾供体项目评估了2107名连续的肾供体候选者；2107名中的2099名（99.6%）完成了评估，2099名中的1578名（75.2%）做出了决定，截至2020年3月12日，1578名中的790名（50.1%）被批准捐赠。通过逻辑回归分析，最有可能被批准的候选者是已婚者或上过大学或技术学校；最不可能被批准的候选者具有以下至少一项特征：黑人种族、吸烟史、高血压、高甘油三酯或高尿白蛋白与肌酐比值。617名候选者未被批准的原因包括慢性肾病风险以外的医疗问题（25.3%）、慢性肾病风险（18.5%）、候选者退出（15.2%）、受者原因（13.6%）、对受者的解剖学风险（10.3%）、非经济心理社会因素（10.3%）、经济因素（0.5%）和其他原因（6.4%）。
这些结果表明，一个全面的活体供体注册对于评估可能为未来活体供体候选者的决策提供信息的长期结果是可行且必要的。捐赠可能存在社会经济障碍，需要更细致地识别，以便采取积极措施解决不平等问题。一些未捐赠的候选者可能是合适的对照，用于判断接受决定的适当性以及捐赠所致的长期结果。我们预计，在未来几年通过修改数据收集方式并将注册扩展到所有中心，这些问题将得到更好的识别。
