Outcomes in living kidney donors over 50 years compared to a healthy matched contemporaneous non-donor cohort from the same geographical region

摘要 对于符合条件的终末期肾病(ESRD)患者，活体供肾(LD)肾移植是最好的选择 选择。但劳工处必须进行一次有手术风险和潜在的长期生活风险的大手术 只有一个肾。一些研究比较了LDS与年龄、性别和种族/民族匹配 一般人口控制没有发现LDS和对照组之间的长期结果差异。 然而，最近比较低密度脂蛋白与健康匹配对照组的研究报告显示，低密度脂蛋白处于 终末期肾病和死亡的风险增加。人们一直对这些国家的LD和控制相匹配表示担忧 研究，包括匹配的对照组，不是同时代的[出生在同一年]；不是来自 同一地理区域；在与捐献日期匹配的日期不知道健康状况；以及 与终末期肾病家族史不匹配。这些因素中的每一个都会影响患肾脏疾病的风险。 以及肾脏疾病的后果。人们一直对有限的后续行动和统计数据感到担忧 这些研究中的分析。事实上，一些评论认为，LD的风险被低估了； 其他人则被高估了。对真实的长期LD风险有一个完整和准确的理解是很重要的 提供数据以通知未来的LD候选人(知情同意)，以及为设计长期 对捐赠者的健康维护/监测。政府机构、其他利益攸关方和法律援助机构本身 要求更高质量的LD结果的长期数据。明尼苏达大学和梅奥大学 诊所有长期的LD移植计划(1963年第一次移植)，数据收集始于 第一次移植的时间。此外，20世纪60年代初的罗切斯特流行病学项目(REP) 建立了一个与奥姆斯特德居民病史相关联的医疗记录系统 县及周边地区(地理位置同U of MN和Mayo诊所)。来自代表的数据已经被 用于提供健康人群的长期数据，并制定了识别健康配对对象的方法 来自代表的控制。我们将在年龄、性别、种族/民族方面将LDS与同时代的代表控制相匹配 以及其他已知的影响肾脏疾病风险的重要特征(例如，体重指数、吸烟史、血液 压力)。我们还将在以下日期匹配LDS和对照组的健康(肾功能正常) 捐赠和肾脏疾病家族史的关系。因为详细的、长期的(&gt；50年的跟踪调查) 在LD和REP数据集中的高质量数据，我们将能够研究并提供关于以下方面的最佳数据：LD风险 ESRD和死亡的风险；在ESRD或死亡之前的更常见的中间事件的LD风险(例如， 肾功能恶化、心血管疾病)；已知危险因素的影响，如体重指数或吸烟 关于捐献的风险；捐献后新发疾病(如糖尿病、高血压)对LD的影响 结果；以及捐献对随后怀孕的影响。我们将提供最全面的数据， 到目前为止，向潜在的LDS通报长期风险，并为当前LDS的后续和护理提供信息。

Abstract For an eligible patient with end stage kidney disease (ESRD), a living donor (LD) kidney transplant is the best option. But the LD has to have a major operation with surgical risks and the potential long-term risks of living with a single kidney. A number of studies comparing LDs with age, gender and race/ethnicity-matched general population controls have found no differences in long-term outcomes between the LDs and controls. However, recent studies comparing LDs to healthy matched controls have reported that the LDs are at increased risk for ESRD and death. There have been concerns about the matching of LDs and controls in these studies, including the matched controls were not contemporaneous [born in the same year]; were not from the same geographic area; were not known to be healthy on the date that matched the date of donation; and were not matched for family history of ESRD. Each of these factors can impact the risk of developing kidney disease and consequences of kidney disease. There have been concerns about the limited follow-up and the statistical analyses in these studies. In fact, some commentaries have suggested that the LD risk was under-estimated; others, overestimated. Having a complete and accurate understanding of true long-term LD risks is important to provide data to inform future LD candidates (informed consent), as well as to inform the design of long-term health maintenance/surveillance of donors. Government agencies, other stakeholders and LDs themselves are asking for better quality long-term data on LD outcomes. The University of Minnesota (U of Mn) and the Mayo Clinic have longstanding LD transplant programs (1st transplant in 1963) with data collection beginning at the time of the first transplant. In addition, the Rochester Epidemiology Project (REP) in the early 1960s established a linked medical records system that has followed the medical history of residents of Olmsted County and surrounding area (same geographic are as U of Mn and Mayo Clinic). Data from the REP has been used to provide long-term data on healthy populations, and methods are in place to identify healthy matched controls from the REP. We will match LDs with contemporaneous REP controls on age, gender, race/ethnicity and other important characteristics known to affect risk of kidney disease (e.g., BMI, smoking history, blood pressure). We will also match LDs and controls for being healthy (with normal renal function) on the date of donation and on family history of kidney disease. Because of the detailed, long-term (>50 year follow-up) quality data in the LD and REP datasets, we will be able to study and provide the best data to date on: LD risk of ESRD and death; LD risk of the much more common intermediate events that precede ESRD or death (e.g., deterioration of kidney function, cardiovascular disease); impact of known risk factors such as BMI or smoking on the risk of donation; the impact of new onset disease after donation (e.g., diabetes, hypertension) on LD outcomes; and the impact of donation on subsequent pregnancies. We will provide most comprehensive data, to date, to inform prospective LDs about long-term risk, and to inform the follow-up and care of current LDs.