Department of Surgery, Royal North Shore Hospital, Sydney, NSW 2065, Australia; Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; Department of Surgery, Westmead Hospital, Sydney, NSW 2145, Australia.
Specialty of Surgery, FMH, University of Sydney, Sydney, NSW 2000, Australia; Department of Vascular Surgery, Royal North Shore Hospital, NSW 2065, Australia.
Transplant Rev (Orlando). 2023 Jan;37(1):100746. doi: 10.1016/j.trre.2022.100746. Epub 2022 Dec 23.
The clinical outcomes of kidney donors with a prior history of nephrolithiasis are poorly defined. We conducted a systematic review assessing the post-donation clinical outcomes of kidney donors with a history of nephrolithiasis. Electronic databases (Ovid and Embase) were searched between 1960 and 2021 using key terms and Medical Subject Headings (MeSH) - nephrolithiasis, renal stones, renal transplantation and renal graft. Articles included conference proceedings and journal articles and were not excluded based on patient numbers. Primary outcome was donor stone-related event. Secondary outcomes were renal function upon follow-up or post-operative nephrectomy complications. In summary, 340 articles were identified through database search. We identified 14 studies (16 cohorts) comprising 432 live donors followed up for a median of 26 months post live kidney donation. Six donors donated the stone-free kidney whilst 23 live donors had bilateral stones. Mean stone size was 4.2 ± 1.4 mm (1-16) with average follow up duration of 21.1 months (1-149). Twelve studies provided primary outcome (n = 138 patients) and eight (n = 348) for secondary outcomes. One donor had a stone-related event upon follow up. A total of 195 patients had eGFR <60 upon follow up. However, they were not significantly different when compared to renal function of live donors that didn't have pre-donation nephrolithiasis. Many of the studies couldn't provide long term follow up, coupled with limited data regarding the nature of the pre-donation stone disease. In conclusion, this systematic review shows that we have very limited information upon which to base recommendation regarding pre-donation risk of post-donation complications. Longer term follow up is required and lifelong follow up with live donor registries will aid further understanding.
肾结石病史对肾供体的临床结局影响尚不清楚。我们进行了一项系统评价，评估肾结石病史对肾供体捐献后的临床结局的影响。使用关键词和医学主题词（MeSH）-肾结石、肾结石、肾移植和肾移植物，在 1960 年至 2021 年期间在电子数据库（Ovid 和 Embase）中进行了检索。文章包括会议记录和期刊文章，不根据患者数量进行排除。主要结局是供体结石相关事件。次要结局是随访时的肾功能或术后肾切除术并发症。总之，通过数据库检索确定了 340 篇文章。我们确定了 14 项研究（16 个队列），包括 432 名活体供体，在活体肾捐献后中位随访 26 个月。6 名供体捐献了无结石的肾脏，而 23 名活体供体有双侧结石。结石平均大小为 4.2±1.4mm（1-16），平均随访时间为 21.1 个月（1-149）。12 项研究提供了主要结局（n=138 例患者），8 项研究（n=348 例）提供了次要结局。1 名供体在随访时发生了结石相关事件。共有 195 名患者在随访时 eGFR<60。然而，与没有术前肾结石的活体供体的肾功能相比，它们没有显著差异。许多研究无法提供长期随访，加上关于术前结石疾病性质的数据有限。总之，本系统评价表明，我们对术前风险与术后并发症之间的关系的了解非常有限。需要进行更长期的随访，并且通过活体供体登记处进行终身随访将有助于进一步了解。
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