Benes Brian, Langewisch Eric D, Westphal Scott G
Nephrology Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
Nephrology Division, Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE.
Adv Kidney Dis Health. 2024 Sep;31(5):387-399. doi: 10.1053/j.akdh.2024.03.002.
Improving access to kidney transplants remains a priority for the transplant community. However, many medical, psychosocial, geographic, and socioeconomic barriers exist that prevent or delay transplantation for candidates with certain conditions. There is a lack of consensus regarding how to best approach many of these issues and barriers, leading to heterogeneity in transplant centers' management and acceptance practices for a variety of pretransplant candidate issues. In this review, we address several of the more common contemporary patient medical and psychosocial barriers frequently encountered by transplant programs. The barriers discussed here include kidney transplant candidates with obesity, older age, prior malignancy, cardiovascular disease, history of nonadherence, and cannabis use. Improving understanding of how to best address these specific issues can empower referring providers, transplant programs, and patients to address these issues as necessary to progress toward eventual successful transplantation.
改善肾移植的可及性仍然是移植界的首要任务。然而，存在许多医学、心理社会、地理和社会经济障碍，这些障碍会阻止或延迟某些病情患者的移植。对于如何最好地处理其中许多问题和障碍，目前尚无共识，这导致移植中心在处理各种移植前候选者问题时，管理和接纳做法存在异质性。在本综述中，我们探讨了移植项目经常遇到的一些较为常见的当代患者医学和心理社会障碍。这里讨论的障碍包括肥胖、高龄、既往有恶性肿瘤、心血管疾病、不依从病史以及使用大麻的肾移植候选者。更好地理解如何最好地处理这些具体问题，能够使转诊医生、移植项目和患者有能力在必要时解决这些问题，以朝着最终成功移植迈进。
