Schweitzer E J, Yoon S, Hart J, Anderson L, Barnes R, Evans D, Hartman K, Jaekels J, Johnson L B, Kuo P C, Hoehn-Saric E, Klassen D K, Weir M R, Bartlett S T
Department of Surgery, University of Maryland Medical School, Baltimore 21201, USA.
Am J Kidney Dis. 1997 May;29(5):739-45. doi: 10.1016/s0272-6386(97)90128-1.
We have generally encouraged living donation among our kidney recipients. However, an examination of our clinical practice revealed inconsistencies in the depth and content of information transmitted to kidney recipient families regarding living donation. We therefore initiated a structured education program, including an educational video, to ensure that all recipient families would receive a similar exposure to a standard block of information. After the program had been functioning for over a year, we compared the living donor (LD) volunteer rates between the 3-year period before (BEFORE) and the 18 months after (AFTER) initiation of the formal education program. There were 1,363 patients registered on our kidney transplantation waiting list during the 54-month study period (757 white [56%] and 580 black [43%]). We found that 33.4% of the kidney transplant candidates in the period BEFORE the LD education program had at least one potential LD tissue typed, compared with 39.4% in the period AFTER starting the program (P = 0.03). The increase in the proportion of patients with potential donors was greatest among the black (P < 0.05) and elderly (P < 0.01) registrants, which were the groups with the lowest volunteer rates before the program began. Among the registrants with at least one potential donor, the percentage of registrants who ultimately received an LD transplant was highly correlated with the number of donors (R = 0.98). The rate of LD kidney transplantation was significantly higher (P = 0.02) for the patients referred in the period AFTER initiation of the LD education program compared with the period BEFORE the program. The 1- and 3-year graft survival rates for the 170 LD transplants performed in these patients were 96.9% and 93.2%, respectively. These were significantly better than the corresponding 83.9% and 71.4% rates for the 341 kidney transplants from cadaver donors in these registrants (P < 0.001). Black recipients of LD transplants had graft survival rates comparable to whites; the 3-year graft survival rate for LD transplants was 93.9% in whites and 90.6% in blacks (P = NS). We conclude that living kidney donor volunteer rates can be improved by a formal family education program, especially for subgroups of patients with low volunteer rates. A substantial benefit is derived by black patients, who generally experience low graft survival rates with cadaver-donor kidneys. A local formal LD education program is a useful adjunct to national organ donation campaigns.
我们总体上鼓励肾移植受者接受活体捐赠。然而，对我们临床实践的检查发现，在向肾移植受者家庭传递的有关活体捐赠的信息深度和内容方面存在不一致之处。因此，我们启动了一项结构化教育计划，包括一部教育视频，以确保所有受者家庭都能接触到类似的标准信息板块。该计划运行一年多后，我们比较了正式教育计划启动前3年期间（之前）和启动后18个月期间（之后）的活体供者（LD）志愿率。在为期54个月的研究期间，有1363名患者登记在我们的肾移植等待名单上（757名白人[56%]和580名黑人[43%]）。我们发现，在LD教育计划之前的时期，33.4%的肾移植候选人至少有一名潜在LD进行了组织配型，而在计划开始后的时期这一比例为39.4%（P = 0.03）。潜在供者患者比例的增加在黑人（P < 0.05）和老年（P < 0.01）登记者中最为显著，他们是计划开始前志愿率最低的群体。在至少有一名潜在供者的登记者中，最终接受LD移植的登记者百分比与供者数量高度相关（R = 0.98）。与计划之前的时期相比，LD教育计划启动后时期转诊的患者的LD肾移植率显著更高（P = 0.02）。在这些患者中进行的170例LD移植的1年和3年移植物存活率分别为96.9%和93.2%。这些显著优于这些登记者中341例尸体供者肾移植相应的83.9%和71.4%的存活率（P < 0.001）。LD移植的黑人受者的移植物存活率与白人相当；LD移植的3年移植物存活率在白人中为93.9%，在黑人中为90.6%（P = 无显著差异）。我们得出结论，正式的家庭教育计划可以提高活体肾供者志愿率，特别是对于志愿率低的患者亚组。黑人患者从中获得了实质性益处，他们接受尸体供者肾移植时通常移植物存活率较低。当地的正式LD教育计划是全国器官捐赠活动的有益补充。
