Long-term consequences of kidney donation.
Long-term consequences of kidney donation.
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DOI：
10.1056/nejmoa0804883
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发表时间：
2009-01-29
期刊：
影响因子：
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通讯作者：
Matas AJ
中科院分区：
文献类型：
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作者：
Ibrahim HN;Foley R;Tan L;Rogers T;Bailey RF;Guo H;Gross CR;Matas AJ
活体供者肾脏捐赠的长期肾脏后果正在吸引越来越多的适当的兴趣。总的证据表明，活体肾供者的生存率与非肾供者相似，而且他们患终末期肾病（ESRD）的风险没有增加。以前的研究包括相对较少的捐赠者和短暂的随访期。我们确定了1963年至2007年期间捐赠肾脏的3698名肾脏捐赠者的重要状态和ESRD的终生风险；从2003年到2007年，我们还测量了255名献血者的肾小球滤过率（GFR）和尿白蛋白排泄，并评估了高血压的患病率、一般健康状况和生活质量。肾脏捐赠者的存活率与年龄、性别、种族或民族相匹配的对照组相似。在11个捐助者中发展了ESRD，每年每百万人中有180例，而一般人口中每年每百万人中有268例。在捐献后平均（±SD） 12.2±9.2年，255名捐献者亚组中85.5%的GFR为每1.73 m2体表面积60 ml / min或更高，32.1%患有高血压，12.7%患有蛋白尿。年龄越大，身体质量指数越高，但献血后时间越长，与GFR低于60 ml / min / 1.73 m2和高血压相关。然而，捐献后较长的时间与蛋白尿独立相关。大多数捐赠者的生活质量得分高于人口标准，共存疾病的患病率与来自国家健康与营养调查（NHANES）的对照组相似，这些对照组在年龄、性别、种族或民族以及体重指数方面相匹配。经过仔细筛选的肾供者的生存率和ESRD的风险似乎与一般人群相似。大多数被研究的供者GFR保存良好，白蛋白排泄正常，生活质量良好。
The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased. Previous studies have included relatively small numbers of donors and a brief follow-up period. We ascertained the vital status and lifetime risk of ESRD in 3698 kidney donors who donated kidneys during the period from 1963 through 2007; from 2003 through 2007, we also measured the glomerular filtration rate (GFR) and urinary albumin excretion and assessed the prevalence of hypertension, general health status, and quality of life in 255 donors. The survival of kidney donors was similar to that of controls who were matched for age, sex, and race or ethnic group. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, as compared with a rate of 268 per million per year in the general population. At a mean (±SD) of 12.2±9.2 years after donation, 85.5% of the subgroup of 255 donors had a GFR of 60 ml per minute per 1.73 m2 of body-surface area or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and higher body-mass index, but not a longer time since donation, were associated with both a GFR that was lower than 60 ml per minute per 1.73 m2 and hypertension. A longer time since donation, however, was independently associated with albuminuria. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic group, and body-mass index. Survival and the risk of ESRD in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved GFR, normal albumin excretion, and an excellent quality of life.