The kidney evaluation of living kidney donor candidates: US practices in 2017
The kidney evaluation of living kidney donor candidates: US practices in 2017
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DOI：
10.1111/ajt.15951
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发表时间：
2020-05-22
影响因子：
8.8
通讯作者：
Mandelbrot, Didier A.
中科院分区：
文献类型：
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作者：
Garg, Neetika;Lentine, Krista L.;Mandelbrot, Didier A.
2017年，我们调查了美国的移植项目，以评估用于评估活体肾脏捐赠者肾脏健康状况的做法；回应率为31%。在这份报告中，我们将重点放在肾脏上；配套的一篇文章将重点放在候选评估的代谢和心血管方面。与2005年相比，该计划在接受年轻候选人方面变得更加严格，而在接受年长候选人方面则变得不那么严格。24小时肌酐清除仍然是肾功能评估的主要指标，74%的人继续使用低于80mL/min/1.73m(2)的值进行排除，22%的人使用基于年龄的标准。APOL1基因分型是常规或选择性的，有45%，其中一半使用高危基因作为绝对排除标准。对于有症状的结石病史，49%的人接受目前没有结石放射学证据并且尿液水平低的风险，80%-95%的人认为有单侧无症状结石的候选人，但只有33%-48%的人考虑结石是否为双侧结石。此外，14%的人经常使用GRAMS等人开发的风险评估工具进行决策，42%的人有时会使用。此外，57%的人报告尚未确定可接受的捐赠后风险的风险阈值，超过该阈值的候选人将被排除在外。当代做法的不同突出表明需要更好的证据来指导捐赠者的选择过程。
We surveyed US transplant programs to assess practices used to assess kidney health in living kidney donor candidates in 2017; the response rate was 31%. In this report, we focus on the kidney; a companion piece focuses on the metabolic and cardiovascular aspects of candidate evaluation. Compared to 2005, programs have become more stringent in accepting younger candidates and less stringent in accepting older candidates. The 24-hour creatinine clearance remains the mainstay for kidney function assessment, with 74% continuing to use a value below 80 mL/min/1.73 m(2) for exclusion and 22% using age-based criteria. ApoL1 genotyping is obtained routinely or selectively by 45%, half of which use the high-risk genotype as an absolute exclusion criterion. For history of symptomatic stones, 49% accept if there is no current radiographic evidence of stones and urine profile is low risk, 80%-95% consider candidates with unilateral asymptomatic stones, but only 33%-48% consider if stones are bilateral. In addition, 14% use the risk assessment tool developed by Grams et al routinely for decision-making, and 42% use it sometimes. Also, 57% reported not having yet determined a risk threshold for acceptable postdonation risk above which candidates are excluded. Contemporary practice variation underscores the need for better evidence to guide the donor selection process.