Long-term risks for kidney donors
Long-term risks for kidney donors
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DOI：
10.1038/ki.2013.460
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发表时间：
2014-07-01
影响因子：
19.6
通讯作者：
Holdaas, Hallvard
中科院分区：
文献类型：
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作者：
Mjoen, Geir;Hallan, Stein;Holdaas, Hallvard
以前的研究表明，活体供肾者可以保持长期的肾功能，并且不会增加心血管或全因死亡率。然而，大多数分析包括健康状况不如活体供者的对照组，并且随访时间相对较短。在这里，我们比较了长期肾功能和心血管和全因死亡率的活体肾脏捐赠者与对照组的个人谁本来有资格捐赠。全因死亡率、心血管死亡率和终末期肾病（ESRD）在1963年至2007年期间捐赠肾脏的1901名个体中确定，中位随访时间为15.1年。选择了32，621名潜在合格肾脏供体的对照组，中位随访时间为24.9年。与对照组相比，供体的全因死亡风险比显著增加至1.30（95%置信区间1.11-1.52）。心血管死亡率相应显著增加至1.40（1.03-1.91），而终末期肾病风险显著增加至11.38（4.37-29.6）。供体中终末期肾病的总发病率为302例/百万，可能受遗传因素影响。免疫性肾病是供者终末期肾病的主要原因。因此，与符合捐献条件的非捐献者对照组相比，肾脏捐献者患终末期肾病、心血管疾病和全因死亡的长期风险增加。
Previous studies have suggested that living kidney donors maintain long-term renal function and experience no increase in cardiovascular or all-cause mortality. However, most analyses have included control groups less healthy than the living donor population and have had relatively short follow-up periods. Here we compared long-term renal function and cardiovascular and all-cause mortality in living kidney donors compared with a control group of individuals who would have been eligible for donation. All-cause mortality, cardiovascular mortality, and end-stage renal disease (ESRD) was identified in 1901 individuals who donated a kidney during 1963 through 2007 with a median follow-up of 15.1 years. A control group of 32,621 potentially eligible kidney donors was selected, with a median follow-up of 24.9 years. Hazard ratio for all-cause death was significantly increased to 1.30 (95% confidence interval 1.11-1.52) for donors compared with controls. There was a significant corresponding increase in cardiovascular death to 1.40 (1.03-1.91), while the risk of ESRD was greatly and significantly increased to 11.38 (4.37-29.6). The overall incidence of ESRD among donors was 302 cases per million and might have been influenced by hereditary factors. Immunological renal disease was the cause of ESRD in the donors. Thus, kidney donors are at increased long-term risk for ESRD, cardiovascular, and all-cause mortality compared with a control group of non-donors who would have been eligible for donation.