Department Urology, University of California Los Angeles, Los Angeles, California, USA.
Department of Epidemiology, University of North Carolina, Chapel Hill, North Carolina, USA.
Am J Transplant. 2022 Jan;22(1):113-121. doi: 10.1111/ajt.16749. Epub 2021 Jul 17.
Nondirected kidney donors can initiate living donor chains that end to patients on the waitlist. We compared 749 National Kidney Registry (NKR) waitlist chain end transplants to other transplants from the NKR and the Scientific Registry of Transplant Recipients between February 2008 and September 2020. Compared to other NKR recipients, chain end recipients were more often older (53 vs. 52 years), black (32% vs. 15%), publicly insured (71% vs. 46%), and spent longer on dialysis (3.0 vs. 1.0 years). Similar differences were noted between chain end recipients and non-NKR living donor recipients. Black patients received chain end kidneys at a rate approaching that of deceased donor kidneys (32% vs. 34%). Chain end donors were older (52 vs. 44 years) with slightly lower glomerular filtration rates (93 vs. 98 ml/min/1.73 m ) than other NKR donors. Chain end recipients had elevated risk of graft failure and mortality compared to control living donor recipients (both p < .01) but lower graft failure (p = .03) and mortality (p < .001) compared to deceased donor recipients. Sharing nondirected donors among a multicenter network may improve the diversity of waitlist patients who benefit from living donation.
非定向肾脏捐献者可以启动活体捐献者链，使等待名单上的患者受益。我们比较了 2008 年 2 月至 2020 年 9 月期间，749 例国家肾脏登记处（NKR）等待名单链末移植与 NKR 和移植受者科学登记处的其他移植。与其他 NKR 受者相比，链末受者年龄更大（53 岁 vs. 52 岁），黑人（32% vs. 15%），公保（71% vs. 46%），透析时间更长（3.0 年 vs. 1.0 年）。在链末受者和非 NKR 活体供者受者之间也注意到了类似的差异。黑人患者接受链末肾脏的比例接近已故供者肾脏（32% vs. 34%）。链末供者年龄更大（52 岁 vs. 44 岁），肾小球滤过率稍低（93 毫升/分钟/1.73 米 2 vs. 98 毫升/分钟/1.73 米 2 ），低于其他 NKR 供者。与对照活体供者受者相比，链末受者的移植物失败和死亡率风险较高（均 p<.01），但与已故供者受者相比，移植物失败（p=.03）和死亡率（p<.001）较低。在多中心网络中共享非定向供者可能会提高受益于活体捐献的等待名单患者的多样性。
