美国一家农村中心活体肾捐献公平性与效率的12年分析

A 12-Year Analysis of Equity and Efficiency in Living Kidney Donation at a Rural American Center.

作者信息

Limburg Benjamin, Dobbs Kaleb, Reuvekamp Els, Sakpal Sujit Vijay

机构信息

Sanford School of Medicine, University of South Dakota, Sioux Falls, South Dakota, USA.

Avera Medical Group Transplant & Liver Surgery, Avera McKennan Hospital & University Health Center, Sioux Falls, South Dakota, USA.

出版信息

Clin Transplant. 2025 Sep;39(9):e70315. doi: 10.1111/ctr.70315.

DOI:10.1111/ctr.70315

PMID:40924854

Abstract

BACKGROUND

In the United States, a severe organ shortage precipitates an extensive transplant waitlist. Living donor kidneys are functionally superior to those from deceased donors and offer an alternative to close the supply-demand gap.

METHODS

A retrospective review of 2147 patients who self-referred to begin the living kidney donation workup process at our center between June 1, 2012, and October 1, 2023 was conducted with subsequent statistical analysis of gathered data. National Kidney Registry (NKR) affiliation began February 1, 2018, and the pre- and post-NKR periods were compared.

RESULTS

The pre-NKR period saw 894 total referrals (42%) compared to 1253 post-NKR (58%). Post-NKR donors increased to 89 from 47 pre-NKR with similar times between stages except for a significantly shorter referral-to-lab review post-NKR (47.0 vs. 56.5 days, p < 0.01). A notable decrease in referrals from Indigenous Peoples was observed (121 [14%] to 93 [7%], p < 0.01) yet donations increased (2 [4%] to 7 [8%], p = 0.042). Donors originating from South Dakota increased (26-54, p = 0.59) post-NKR, and significantly more patients pursued nondirected referral (25 [3%] vs. 173 [14%], p < 0.01) with similar proportions following through with donation. Reasons for dropout during the process were similar between the periods, yet quantitative distributions differed.

CONCLUSION

NKR affiliation coincided with encouraging results, in many cases similar to broad national trends, attesting to improved connectivity and impact on focal population groups.

摘要

背景

在美国，严重的器官短缺导致大量患者加入移植等待名单。活体供肾在功能上优于死体供肾，是缩小供需差距的一种替代方案。

方法

对2012年6月1日至2023年10月1日期间自行到本中心开始活体肾捐献检查流程的2147例患者进行回顾性研究，并对收集的数据进行后续统计分析。自2018年2月1日起加入国家肾脏登记处（NKR），并比较加入NKR前后的时期。

结果

加入NKR前共收到894例转诊（42%），加入NKR后为1253例（58%）。加入NKR后捐献者从47例增加到89例，各阶段时间相似，但加入NKR后从转诊到实验室检查的时间明显缩短（47.0天对56.5天，p<0.01）。观察到原住民的转诊显著减少（从121例[14%]降至93例[7%]，p<0.01），但捐献增加（从2例[4%]增至7例[8%]，p=0.042）。加入NKR后，来自南达科他州的捐献者增加（26例对54例，p=0.59），并且更多患者选择非定向转诊（25例[3%]对173例[14%]，p<0.01），捐献完成比例相似。两个时期内，流程中退出的原因相似，但定量分布不同。