Racial disparities in living kidney donation: Is there a lack of willing donors or an excess of medically unsuitable candidates?
Racial disparities in living kidney donation: Is there a lack of willing donors or an excess of medically unsuitable candidates?
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DOI：
10.1097/01.tp.0000232693.69773.42
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发表时间：
2006-10-15
期刊：
影响因子：
6.2
通讯作者：
Baliga, Prabhakar K.
中科院分区：
文献类型：
--
作者：
Lunsford, Shayna L.;Simpson, Kit S.;Baliga, Prabhakar K.
背景活体肾脏捐献对健康供体是安全的，对终末期肾病患者是有效的治疗方法。许多潜在的捐赠者被推荐进行活体肾脏捐赠，但只有一小部分捐赠。本研究旨在确定不捐献的原因，并确定是否存在种族差异。对2000年1月1日至2004年12月31日期间所有可能进行活体肾脏捐献的患者进行回顾性数据库和图表分析。总的来说，30.3%的潜在活体肾脏捐赠者失访。不捐献的主要原因（n= 1，050）包括供体健康状况不佳（43.1%）和基于遗传的原因（41.3%）。免疫不相容占所有非献血者的9.7%。种族差异显示，更多的非洲裔美国人血型不合（P=0.01）或不合格的受体（26.7%比14.4%，P < 0.01）。更多的非非洲裔美国人捐献（13.2%比4.6%，P < 0.01）或因潜在受体接受另一个器官（活体/尸体）而停止（20.0%比7.9%，P < 0.01）。由于捐献者的整体健康状况（包括糖尿病和高血压）而导致的不捐献在种族间没有差异，但亚组分析表明更多的非裔美国人不捐献是由于高体重指数（P=0.01）。确定不捐献背后的原因是了解活体肾脏捐献率低的第一步。更多的非洲裔美国人捐助者转介失访，而其他原因的比率在种族之间相似。这可能表明，非裔美国人在医学上并不是更不合适，但活体肾脏捐赠率的差异是由非裔美国人之间捐赠意愿的差异造成的。
Background. Live kidney donation is safe for healthy donors and an effective treatment for patients with end-stage renal disease. Many potential donors are referred for live kidney donation, but only a small percentage donate. This study aims to determine reasons for nondonation and establish if racial differences exist.Methods. A retrospective database and chart review of all patients that were referred for potential live kidney donation from January 1, 2000 to December 31, 2004 was conducted.Results. In all, 30.3% of referred potential live kidney donors were lost to follow-up. Primary reasons for nondonation (n=1,050) included unsuitable donor health (43.1%) and recipient-based causes (41.3%). Immunologic incompatibility accounted for 9.7% of all nondonations. Racial differences indicated more African Americans had incompatible blood types (P=0.01) or ineligible recipients (26.7% vs. 14.4%, P < 0.01). More non-African Americans donated (13.2% vs. 4.6%, P < 0.01) or were halted because the potential recipient received another organ (living/cadaveric) (20.0% versus 7.9%), P < 0.01). Nondonation due to overall donor health (including diabetes and hypertension) did not differ between races, but subanalysis indicated more African American nondonation was due to high body mass index (P=0.01).Conclusions. Determining the reason behind nondonation is a first step towards understanding low rates of live kidney donation. More African American donor referrals are lost to follow-up while rates of other reasons were similar among races. This may indicate that African Americans are not more frequently medically unsuitable, but that the divergence in rates of live kidney donation is caused by a disparity in willingness to donate among African Americans.