Laham Gustavo, Ponti Juan Pablo, Soler Pujol Gervasio
Internal Medicine Department, Nephrology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina.
Front Med (Lausanne). 2022 Feb 2;8:784435. doi: 10.3389/fmed.2021.784435. eCollection 2021.
Kidney transplantation (KT) is the treatment of choice for patients with end-stage kidney disease (ESKD) with decreased morbi-mortality, improved life quality, and reduced cost. However, the shortage of organs from deceased donors led to an increase in KT from living donors. Some stipulate that living donors have a higher risk of ESKD after donation compared with healthy non-donors. The reason for this is not clear. It is possible that ESKD is due to the nephrectomy-related reduction in glomerular filtration rate (GFR), followed by an age-related decline that may be more rapid in related donors. It is essential to assess donors properly to avoid rejecting suitable ones and not accepting those with a higher risk of ESKD. GFR is a central aspect of the evaluation of potential donors since there is an association between low GFR and ESKD. The methods for assessing GFR are in continuous debate, and the kidney function thresholds for accepting a donor may vary according to the guidelines. While direct measurements of GFR (mGFR) provide the most accurate evaluation of kidney function, guidelines do not systematically use this measurement as a reference. Also, some studies have shown that the GFR decreases with age and may vary with gender and race, therefore, the lower limit of GFR in patients eligible to donate may vary based on these demographic factors. Finally, it is known that CrCl overestimates mGFR while eGFR underestimates it, therefore, another way to have a reliable GFR could be the combination of two measurement methods.
肾移植（KT）是终末期肾病（ESKD）患者的首选治疗方法，可降低病死亡率、提高生活质量并降低成本。然而， deceased供体器官的短缺导致活体供体肾移植数量增加。一些人规定，与健康非供体相比，活体供体在捐献后发生ESKD的风险更高。其原因尚不清楚。有可能ESKD是由于肾切除相关的肾小球滤过率（GFR）降低，随后是与年龄相关的下降，这在相关供体中可能更快。正确评估供体以避免拒绝合适的供体并避免接受ESKD风险较高的供体至关重要。GFR是评估潜在供体的核心方面，因为低GFR与ESKD之间存在关联。评估GFR的方法一直存在争议，接受供体的肾功能阈值可能因指南而异。虽然直接测量GFR（mGFR）可提供对肾功能最准确的评估，但指南并未系统地将此测量用作参考。此外，一些研究表明，GFR随年龄下降，可能因性别和种族而异，因此，符合捐献条件患者的GFR下限可能因这些人口统计学因素而有所不同。最后，已知肌酐清除率（CrCl）高估mGFR，而估算肾小球滤过率（eGFR）低估mGFR，因此，获得可靠GFR的另一种方法可能是将两种测量方法结合使用。
