Department of Surgery, Houston Methodist Hospital, Houston, Texas, USA.
Department of Pathology and Genomic Medicine, Houston Methodist Research Institute, Houston, Texas, USA.
Clin Transplant. 2024 Sep;38(9):e15439. doi: 10.1111/ctr.15439.
Living donor kidney transplantation is the optimal treatment for end-stage kidney disease; however, few living donor candidates (LDCs) who begin evaluation actually donate. While some LDCs are deemed medically ineligible, others discontinue for potentially modifiable reasons.
At five transplant centers, we conducted a prospective cohort study measuring LDCs' clinical and psychosocial characteristics, educational preparation, readiness to donate, and social determinants of health. We followed LDCs for 12 months after evaluation to determine whether they donated a kidney, opted to discontinue, had modifiable reasons for discontinuing, were medically ineligible, or had other recipient-related reasons for discontinuing.
Among 2184 LDCs, 18.6% donated, 38.2% opted to or had modifiable reasons for discontinuing, and 43.2% were deemed ineligible due to medical or recipient-related reasons. Multivariable analyses comparing successful LDCs with those who did not complete donation for modifiable reasons (N = 1241) found that LDCs who discussed donation with the recipient before evaluation (OR, 2.31; 95% CI, 1.54-3.46), had completed high school (OR, 2.01; 95% CI, 1.21-3.35), or were a "close relation" to their recipient (OR, 1.89; 95% CI, 1.33-2.69) were more likely to donate. Conversely, LDCs who reported religion as important (OR, 0.55; 95% CI, 0.38-0.80), were Non-White (OR, 0.70; 95% CI, 0.49-1.00), or had overall higher anxiety scores (OR, 0.92; 95% CI, 0.86-0.99) were less likely to donate.
With fewer than a fifth of LDCs donating, developing programs to provide greater emotional support and facilitate open discussions between LDCs and recipients earlier may increase living donation rates.
活体供肾移植是治疗终末期肾病的最佳方法；然而，在开始评估的活体供者中，只有少数人实际捐献。虽然有些活体供者被认为不适合捐献，但其他人因潜在的可改变的原因而停止。
在五个移植中心，我们进行了一项前瞻性队列研究，测量活体供者的临床和社会心理特征、教育准备、捐献意愿和健康的社会决定因素。我们在评估后对活体供者进行了 12 个月的随访，以确定他们是否捐献了肾脏、选择停止、有可改变的停止原因、因医学或受体相关原因而不适合捐献，或因其他受体相关原因而停止。
在 2184 名活体供者中，18.6%捐献，38.2%选择或有可改变的停止原因，43.2%因医学或受体相关原因而不适合捐献。将成功的活体供者与因可改变的原因而未完成捐赠的供者（n=1241）进行多变量分析发现，在评估前与受体讨论过捐赠的活体供者（OR，2.31；95%CI，1.54-3.46）、完成了高中学业（OR，2.01；95%CI，1.21-3.35）或与受体有“亲密关系”（OR，1.89；95%CI，1.33-2.69）的供者更有可能捐献。相反，报告宗教重要的供者（OR，0.55；95%CI，0.38-0.80）、非白人（OR，0.70；95%CI，0.49-1.00）或总体焦虑评分较高的供者（OR，0.92；95%CI，0.86-0.99）不太可能捐献。
由于只有不到五分之一的活体供者捐献，因此开发方案提供更大的情感支持，并促进活体供者和受体之间更早的公开讨论，可能会提高活体捐献率。
