Risk of ESRD in prior living kidney donors
Risk of ESRD in prior living kidney donors
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DOI：
10.1111/ajt.14678
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发表时间：
2018-05-01
影响因子：
8.8
通讯作者：
Stewart, Darren E.
中科院分区：
文献类型：
--
作者：
Wainright, Jennifer L.;Robinson, Amanda M.;Stewart, Darren E.
我们研究了1994年至2016年期间在美国捐赠的活体肾脏捐赠者（LKD）的终末期肾病（ESRD）（n = 123526），使用器官采购和移植网络以及医疗保险和医疗补助服务中心的数据。218例LKD发展为ESRD，从捐赠到ESRD的中位时间为11.1年。绝对20年风险较低，但并不均匀，风险与种族，年龄和性别相关，并随时间呈指数增长。如果LKD是男性，（校正风险比[aHR]：1.75，95%置信区间[95%CI]：1.33 - 2.31），BMI较高（aHR：1.34/5kg/m（2），95%CI：1.10 - 1.64）或GFR估计值更低（aHR：0.89/10 mL/min，95% CI：0.80 - 0.99），是受体的一级亲属（父母：[aHR：2.01，95%CI：1.26 - 3.21];同胞[aHR：1.87，95%CI：1.23 - 2.84];同卵双胞胎[aHR：19.79，95%CI：7.65 - 51.24]），或捐赠时居住在社会经济地位较低的社区（aHR：每增加1万美元0.87; 95%CI：0.77 - 0.99）。我们发现捐献年龄和种族之间存在显著的相互作用，白色LKD的年龄越大风险越高（aHR：1.26/10年，95%CI：1.04 - 1.54），但黑人LKD的年龄越小风险越高（aHR：0.75/10年，95%CI：0.57 - 0.99）。这些发现进一步告知潜在LKDs.The终末期肾脏疾病的20年风险在活体肾脏捐赠者之间并不统一，捐赠者的社会经济地位，eGFR，种族，性别，与受体的相关性，以及捐赠时的年龄与肾脏疾病的风险相关。参见Matas等人在1140页上的配套文章，以及Gill在1041页上的社论。
We studied End-Stage Renal Disease (ESRD) in living kidney donors (LKDs) who donated in the United States between 1994 and 2016 (n=123526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. Two hundred eighteen LKDs developed ESRD, with a median of 11.1years between donation and ESRD. Absolute 20-year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKDs had increased risk of ESRD if they were male (adjusted hazard ratio [aHR]: 1.75, 95% confidence interval [95%CI]: 1.33-2.31), had higher BMI (aHR: 1.34 per 5kg/m(2), 95%CI: 1.10-1.64) or lower estimated GFR (aHR: 0.89 per 10 mL/min, 95% CI: 0.80-0.99), were first-degree relatives of the recipient (parent: [aHR: 2.01, 95% CI: 1.26-3.21]; full sibling [aHR: 1.87, 95%CI: 1.23-2.84]; identical twin [aHR: 19.79, 95%CI: 7.65-51.24]), or lived in lower socioeconomic status neighborhoods at donation (aHR: 0.87 per $10k increase; 95%CI: 0.77-0.99). We found a significant interaction between donation age and race, with higher risk at older ages for white LKDs (aHR: 1.26 per decade, 95%CI: 1.04-1.54), but higher risk at younger ages for black LKDs (aHR: 0.75 per decade, 95%CI: 0.57-0.99). These findings further inform risk assessment of potential LKDs.The 20-year risk of end-stage renal disease in living kidney donors is not uniform among donors, and donor socioeconomic status, eGFR, race, sex, relatedness to recipient, and age at donation are associated with risk of renal disease. See the companion article on page 1140 from Matas etal, and an editorial from Gill on page 1041.