A Case-Based Analysis of Whether Living Related Donors Listed for Transplant Share ESRD Causes with Their Recipients
A Case-Based Analysis of Whether Living Related Donors Listed for Transplant Share ESRD Causes with Their Recipients
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DOI：
10.2215/cjn.11421116
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发表时间：
2017-04-01
影响因子：
9.8
通讯作者：
Ibrahim, Hassan N.
中科院分区：
文献类型：
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作者：
Matas, Arthur J.;Hays, Rebecca E.;Ibrahim, Hassan N.
背景和目的最近的两项研究报告了肾脏捐献后ESRD的风险增加。在这两种情况下，大多数ESRD发生在那些向亲属捐献的人身上。混淆这一观察结果的是，在没有捐献的情况下，ESRD患者的亲属发生ESRD的风险增加。了解捐赠后ESRD的发病机制和危险因素对捐赠者选择和咨询至关重要。设计、设置、参与者和测量我们假设，如果家族关系是发病机制的重要考虑因素，那么供体和相关受体可能具有相同的ESRD病因。我们从器官获取和移植网络（OPTN）获得了1996年1月1日至2015年11月30日期间在美国等待肾脏移植的所有活体肾脏捐赠者的信息，以确定(1)供体-受体关系和(2)相关供体-受体对是否有相似的ESRD原因。结果我们发现，在上市时可能可用的大量信息没有报告给OPTN。在441名被列入移植名单的肾脏捐赠者中，只有169名有信息可以确定从捐赠到列入名单的时间间隔，只有99名（占总数的22%）有供体受体关系和ESRD病因的信息。在99名捐赠者中，有87人与他们的接受者有亲属关系。引人注目的是，在87例中，只有少数（23%）供体-受体对具有ESRD病因。排除高血压，只有8%的人有相同的病因。为了更好地了解供体ESRD，需要收集完整和详细的数据，以及一种捕捉所有ESRD终点的方法。这项研究强调了对肾脏捐献后ESRD的重要信息的缺乏，而这些信息是迫切需要的。我们发现，在列出的移植活体相关供者中，记录了供者和受者的ESRD病因，只有少数人与受者有相同的ESRD病因。
Background and objectives Two recent studies reported increased risk of ESRD after kidney donation. In both, the majority of ESRD was seen in those donating to a relative. Confounding this observation is that, in the absence of donation, relatives of those with ESRD are at increased risk for ESRD. Understanding the pathogenesis and risk factors for postdonation ESRD is critical for both donor selection and counseling.Design, setting, participants, & measurements We hypothesized that if familial relationship was an important consideration in pathogenesis, the donor and linked recipient would share ESRD etiology. We obtained information from the Organ Procurement and Transplantation Network (OPTN) on all living kidney donors subsequently waitlisted for a kidney transplant in the United States between January 1, 1996 and November 30, 2015, to determine (1) the donor-recipient relationship and (2) whether related donor-recipient pairs had similar causes of ESRD.Results We found that a significant amount of information, potentially available at the time of listing, was not reported to the OPTN. Of 441 kidney donors listed for transplant, only 169 had information allowing determination of interval from donation to listing, and only 99 (22% of the total) had information on the donor recipient relationship and ESRD etiology. Of the 99 donors, 87 were related to their recipient. Strikingly, of the 87, only a minority (23%) of donor-recipient pairs shared ESRD etiology. Excluding hypertension, only 8% shared etiology.Conclusions A better understanding of ESRD in donors requires complete and detailed data collection, as well as a method to capture all ESRD end points. This study highlights the absence of critical information that is urgently needed to provide a meaningful understanding of ESRD after kidney donation. We found that of living related donors listed for transplant, where both donor and recipient cause of ESRD is recorded, only a minority share ESRD etiology with their recipient.