Factors limiting the rate of living-related kidney donation to children in an inner city setting
Factors limiting the rate of living-related kidney donation to children in an inner city setting
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DOI：
10.1034/j.1399-3046.2001.t01-2-00033.x
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发表时间：
2001-12-01
影响因子：
1.3
通讯作者：
Singh, A
中科院分区：
文献类型：
--
作者：
Hidalgo, G;Tejani, C;Singh, A
最近对我们中心经验的回顾显示，我们只有38%的儿科肾移植来自固定相关供体（LRD）。比全国平均水平低11%。本研究旨在确定限制我们人群中可用性或LRD的因素。我们对1990年至1999年在我们机构接受肾脏替代治疗（RRT）的所有儿童的父母进行了回顾性病历审查和随后的电话采访。记录父母的可用性和他们的肾脏捐赠意愿。自我报告的意愿定义为口头表达。捐赠的愿望。坚定的意愿被定义为完成捐赠的必要步骤，除非被医疗团队排除在外。评估了可能影响捐献能力的因素，如捐献者年龄、种族、宗教、教育程度、就业和其他18岁以下兄弟姐妹的存在。使用Student t检验和卡方分析进行统计学分析。将显著结果输入单步多元回归分析。60名儿童被确定为RRT，或其中60%是黑人，30%是西班牙裔。7%白人，3%亚洲人。55位母亲接受了采访。44位母亲报告了捐赠的愿望。九人不愿意捐献，两人尚未决定。然而，只有35人参加了筛查。只有30名父亲可以参加，其中27人表示愿意捐献，但只有20人参加了筛查。74%（35人中有26人）或母亲接受了筛查，55%接受了筛查。(11在20名接受筛查的父亲中，有20名在医学上不适合捐肾。19名潜在供体患有高血压、糖尿病和/或肥胖症，7名患有肾病，4名患有贫血。两人患有丙型肝炎，五人患有其他疾病。表达不愿意捐献与更多的儿童（3.1对1.5，除了患有终末期肾病[ESRD]的儿童）（比值比2.91，p < 0.05）和就业（26.3%对4.0%）相关。p < 0.05）（优势比31.2，p = 0.05）。将坚定愿意捐献的母亲与未完成筛查和评估的母亲进行比较。不情愿的妈妈们我也是更多的儿童（2.9比1.2，加上患有ESRD的儿童）（优势比3.23，p < 0.01）和更多的受教育年限（12.4比10.4）（优势比2.14）。P < 0.05）。因此，由于单亲比例高和父母捐献者中合并症比例高，我们内城儿童活体肾脏捐献者的可用性受到严重限制。此外，现有的父母，特别是母亲，捐赠的能力减弱，因为她往往有许多其他受抚养人。
A recent review of our center experience revealed that only 38% of our pediatric renal transplants come from fixing-related donors (LRD). which is 11% lower than the national average. The present study was designed to identify factors that limit the availability or LRD in Our population pool. Retrospective chart reviews and subsequent telephone interviews were conducted with parents of all children who received renal replacement therapy (RRT) at our institution from 1990 to 1999. The availability of parents and their willingness to donate a kidney were noted, Self-reported willingness was defined as the verbal expression of a. desire to donate. Firm willingness was defined as the completion of the steps necessary for donation, unless excluded by the medical team. Factors that, may impact the ability to donate, such as donor age, ethnicity, religion, educational attainment, employment, and presence of other siblings younger than 18 yr of age, were evaluated. Statistical analyses were performed using the Student's t-test and chi-square analysis. Significant results were entered into a single-step multiple regression analysis. Sixty children were identified with RRT, or whom 60% were Blacks, 30% Hispanics. 7% Caucasians, and 3% Asian. Fifty-five mothers were available for interview. Forty-four mothers reported a desire to donate. nine were unwilling to donate, and two were undecided. However, only 35 attended for screening. Only 30 fathers were available and, of these, 27 reported willingness to donate, yet only 20 attended for screening. Seventy-four per cent (26 out of 35) or mothers screened and 55%. (11 out of 20) of fathers screened were medically unsuitable for kidney donation. Nineteen potential donors had hypertension, diabetes and/or obesity, seven had renal disease, four had anemia. two had hepatitis C, and five had other conditions. Expressed unwillingness to donate was associated with a greater number of children (3.1 compared to 1.5 children in addition to the child with end-stage renal disease [ESRD]) (odds ratio 2.91, p < 0.05) and, employment (26.3%, vs. 4.0%). p < 0.05) (odds ratio 31.2, p = 0.05). Comparing mothers who were firmly willing to donate with mothers who did not complete screening and evaluation. unwilling mothers had. likewise. a greater number of children (2.9 vs. 1.2 in addition to the child with ESRD) (odds ratio 3.23, p < 0.01) and a greater number of years of education (12.4 vs. 10.4) (odds ratio 2.14. p < 0.05). Hence, the availability of living kidney donors for our inner city children is severely limited by a high rate of single parenthood and a high rate of comorbid conditions in the parental donor pool. Furthermore, there is a diminished capacity of the available parent, particularly the mother, to donate as she tends to have numerous other dependents.