RESUMEN
INTRODUCTION: Adults residing in deprived neighborhoods face various socioeconomic stressors, hindering their likelihood of receiving live-donor kidney transplantation (LDKT) and preemptive kidney transplantation (KT). We quantified the association between residential neighborhood deprivation index (NDI) and the likelihood of LDKT/preemptive KT, testing for a differential impact by race and ethnicity. METHODS: We studied 403 937 adults (age ≥ 18) KT candidates (national transplant registry; 2006-2021). NDI and its 10 components were averaged at the ZIP-code level. Cause-specific hazards models were used to quantify the adjusted hazard ratio (aHR) of LDKT and preemptive KT across tertiles of NDI and its 10 components. RESULTS: Candidates residing in high-deprivation neighborhoods were more likely to be female (40.1% vs. 36.2%) and Black (41.9% vs. 17.7%), and were less likely to receive both LDKT (aHR = 0.66, 95% confidence interval [CI]: 0.64-0.67) and preemptive KT (aHR = 0.60, 95% CI: 0.59-0.62) than those in low-deprivation neighborhoods. These associations differedby race and ethnicity (Black: aHRLDKT = 0.58, 95% CI: 0.55-0.62; aHRpreemptive KT = 0.68, 95% CI: 0.63-0.73; Pinteractions: LDKT < 0.001; Preemptive KT = 0.002). All deprivation components were associated with the likelihood of both LDKT and preemptive KT (except median home value): for example, higher median household income (LDKT: aHR = 1.08, 95% CI: 1.07-1.09; Preemptive KT: aHR = 1.10, 95% CI: 1.08-1.11) and educational attainments (≥high school [LDKT: aHR = 1.17, 95% CI: 1.15-1.18; Preemptive KT: aHR = 1.23, 95% CI: 1.21-1.25]). CONCLUSION: Residence in socioeconomically deprived neighborhoods is associated with a lower likelihood of LDKT and preemptive KT, differentially impacting minority candidates. Identifying and understanding which neighborhood-level socioeconomic status contributes to these racial disparities can be instrumental in tailoring interventions to achieve health equity in LDKT and preemptive KT.
Asunto(s)
Trasplante de Riñón , Donadores Vivos , Características del Vecindario , Humanos , Femenino , Masculino , Donadores Vivos/provisión & distribución , Persona de Mediana Edad , Adulto , Estudios de Seguimiento , Pronóstico , Características de la Residencia , Fallo Renal Crónico/cirugía , Factores Socioeconómicos , Sistema de Registros/estadística & datos numéricos , Factores de Riesgo , Adulto Joven , AdolescenteRESUMEN
Solid-organ transplantation remains the optimal therapeutic option for end-stage organ disease. Altruistic donation represents the ultimate sign of generosity and the most important gift of life. Currently, <10% of the global needs for transplant are fulfilled. Organ shortages result from an inability to provide an adequate organ supply to match demands. The recently observed stagnation in living kidney donations in the United States is related to a drop in all types of organ donations from living related donors, which has been paralleled with a steady and continuous increase in all living unrelated donations. Some forms of living unrelated donation represent a financially driven survival system within which wealthy recipients exploit poor donors. Low rates of altruistic donation are related to cultural barriers, religious obstacles, fear, and consequent distrust in the system. The low rate indicates a state of lack of societal solidarity, a consequence of the state of subconsciousness at the individual and collective levels that humanity is living in. Human domestication, the conditioning process that humans go through since birth and the primary facilitator of this subconscious state, is guarded through familial, social, cultural, religious, political, and mass media organizations, which are all under the influence of the monetary establishment. Acquired beliefs, mainly during the domestication process, influence our perception of the environment, our values, and ultimately our way of life. Unfortunately, this conditioning process is negatively enforced, leading to a stressful state. The powerful subconscious mind places humans in a permanent survival mode, resulting in loss of intelligence, indispensable for well-being and happiness. Altruistic donation requires a close cooperation between all parties involved in the donation process and necessitates a positive reprograming of our subconscious based on sharing, generosity, satisfaction, gratitude, trust, inner peace, and ultimately happiness, well-known constituents of unconditional love, which represents the peak of consciousness.
Asunto(s)
Altruismo , Donadores Vivos , Obtención de Tejidos y Órganos , Humanos , Donadores Vivos/psicología , Donadores Vivos/provisión & distribución , Donaciones , Motivación , Conocimientos, Actitudes y Práctica en Salud , Trasplante de Órganos/psicología , Necesidades y Demandas de Servicios de Salud , Características Culturales , Donante no Emparentado/psicologíaRESUMEN
The first living donor kidney transplant in Syria was performed 44 years ago; by the end of 2022, 6265 renal transplants had been performed in Syria. Kidney, bone marrow, cornea, and stem cells are the only organs or tissues that can be transplanted in Syria. Although 3 heart transplants from deceased donors were performed in the late 1980s, cardiac transplant activities have since discontinued. In 2003, national Syrian legislation was enacted authorizing the use of organs from living unrelated and deceased donors. This important law was preceded by another big stride: the acceptance by the higher Islamic religious authorities in Syria in 2001 of the principle of procurement of organs from deceased donors, provided that consent is given by a first- or second-degree relative. After the law was enacted, kidney transplant rates increased from 7 per million population in 2002 to 17 per million population in 2007. Kidney transplants performed abroad for Syrian patients declined from 25% in 2002 to <2% in 2007. Rates plateaued through 2010, before the political crisis started in 2011. Forty-four years after the first successful kidney transplant in Syria, patients needing an organ transplant rely on living donors only. Moreover, 20 years after the law authorizing use of organs from deceased donors, a program is still not in place in Syria. The war, limited resources, and lack of public awareness about the importance of organ donation and transplant appear to be factors inhibiting initiation of a deceased donor program in Syria. A concerted and ongoing education campaign is needed to increase awareness of organ donation, change negative public attitudes, and gain societal acceptance. Every effort must be made to initiate a deceased donor program to lessen the burden on living donors and to enable national self-sufficiency in organs for transplant.
Asunto(s)
Donadores Vivos , Trasplante de Órganos , Donantes de Tejidos , Obtención de Tejidos y Órganos , Humanos , Siria , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/tendencias , Trasplante de Órganos/legislación & jurisprudencia , Trasplante de Órganos/tendencias , Donadores Vivos/provisión & distribución , Donadores Vivos/legislación & jurisprudencia , Donantes de Tejidos/provisión & distribución , Donantes de Tejidos/legislación & jurisprudencia , Religión y Medicina , Trasplante de Riñón/legislación & jurisprudencia , Islamismo , Factores de Tiempo , Política de Salud/legislación & jurisprudencia , Regulación GubernamentalAsunto(s)
Trasplante de Riñón , Donadores Vivos , Obtención de Tejidos y Órganos , Humanos , América Latina , Trasplante de Riñón/estadística & datos numéricos , Región del Caribe , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/estadística & datos numéricos , Donadores Vivos/provisión & distribuciónRESUMEN
Living donor kidney transplantation (LDKT) is one of the most effective treatment options for people with end-stage renal disease. Traditionally, LDKT can be either "directed" or "nondirected," based on whether the recipient is specified by the donor. Recently, there has been an increase in conditional and semidirected live kidney donation among strangers, where the donor specifies the characteristics of the recipient whom they wish to donate to. This practice has both gained popularity and sparked controversy in the state of Israel through the nonprofit organization Matnat Chaim. We analyze the ethical implications of this practice by applying traditional principles of medical ethics to conditional LDKT. Although semidirected and conditional LDKT presents some ethical challenges, overall, its practice effectively aligns with core ethical principles. The donors' right to make stipulations respects the donor's autonomy, the practice avoids harm and benefits both donor and recipient, and justice and utility are upheld as the practice specifically benefits marginalized patients and optimizes resource utilization. Finally, we present data from our institution demonstrating how conditional LDKT increased transplantation for all ethnic groups; Jewish recipients of LDKT increased by 151.32% (P = .034) Arab recipients of LDKT increased by 111.11% (P = .036).
Asunto(s)
Fallo Renal Crónico , Trasplante de Riñón , Donadores Vivos , Obtención de Tejidos y Órganos , Humanos , Trasplante de Riñón/ética , Donadores Vivos/provisión & distribución , Donadores Vivos/ética , Israel , Fallo Renal Crónico/cirugía , Obtención de Tejidos y Órganos/ética , Análisis Ético , Masculino , FemeninoRESUMEN
OBJECTIVE: Longer end-stage renal disease time has been associated with inferior kidney transplant outcomes. However, the contribution of transplant evaluation is uncertain. We explored the relationship between time from evaluation to listing (ELT) and transplant outcomes. METHODS: This retrospective study included 2535 adult kidney transplants from 2000 to 2015. Kaplan-Meier survival curves, log-rank tests, and Cox regression models were used to compare transplant outcomes. RESULTS: Patient survival for both deceased donor (DD) recipients (p < .001) and living donor (LD) recipients (p < .0001) was significantly higher when ELT was less than 3 months. The risks of ELT appeared to be mediated by other risks in DD recipients, as adjusted models showed no associated risk of graft loss or death in DD recipients. For LD recipients, ELT remained a risk factor for patient death after covariate adjustment. Each month of ELT was associated with an increased risk of death (HR = 1.021, p = .04) but not graft loss in LD recipients in adjusted models. CONCLUSIONS: Kidney transplant recipients with longer ELT times had higher rates of death after transplant, and ELT was independently associated with an increased risk of death for LD recipients. Investigations on the impact of pretransplant evaluation on post-transplant outcomes can inform transplant policy and practice.
Asunto(s)
Supervivencia de Injerto , Fallo Renal Crónico , Trasplante de Riñón , Listas de Espera , Humanos , Trasplante de Riñón/mortalidad , Trasplante de Riñón/efectos adversos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Fallo Renal Crónico/cirugía , Estudios de Seguimiento , Factores de Riesgo , Listas de Espera/mortalidad , Pronóstico , Tasa de Supervivencia , Adulto , Rechazo de Injerto/etiología , Rechazo de Injerto/mortalidad , Donantes de Tejidos/provisión & distribución , Tasa de Filtración Glomerular , Pruebas de Función Renal , Donadores Vivos/provisión & distribución , Obtención de Tejidos y Órganos , Factores de Tiempo , Complicaciones PosoperatoriasRESUMEN
Kidney transplantation is the most successful kidney replacement therapy available, resulting in improved recipient survival and societal cost savings. Yet, nearly 70 years after the first successful kidney transplant, there are still numerous barriers and untapped opportunities that constrain the access to transplant. The literature describing these barriers is extensive, but the practices and processes to solve them are less clear. Solutions must be multidisciplinary and be the product of strong partnerships among patients, their networks, health care providers, and transplant programs. Transparency in the referral, evaluation, and listing process as well as organ selection are paramount to build such partnerships. Providing early culturally congruent and patient-centered education as well as maximizing the use of local resources to facilitate the transplant work up should be prioritized. Every opportunity to facilitate pre-emptive kidney transplantation and living donation must be taken. Promoting the use of telemedicine and kidney paired donation as standards of care can positively impact the work up completion and maximize the chances of a living donor kidney transplant.
Asunto(s)
Accesibilidad a los Servicios de Salud , Fallo Renal Crónico , Trasplante de Riñón , Obtención de Tejidos y Órganos , Humanos , Obtención de Tejidos y Órganos/métodos , Fallo Renal Crónico/cirugía , Donadores Vivos/provisión & distribución , Listas de EsperaRESUMEN
Racial disparities in pediatric kidney transplantation have been well described over the last two decades and include disparities in preemptive transplantation, waitlisting, time from activation to transplantation, living donation, and graft outcomes. Changes to the organ allocation system including the institution of Share 35 in 2005 and the Kidney Allocation System (KAS) of 2014 have resulted in resolution of some, but not all racial-ethnic disparities. Despite overall improvements in time from waitlist activation to transplant, disparities remain in preemptive transplantation, time to waitlisting, and living donor transplantation. Although improving under the KAS, racial disparities remain in graft survival as well. Racial disparity in kidney transplant access and graft survival is an international problem within pediatric nephrology. Although the racial group affected may differ, various minoritized pediatric groups across the world are affected by transplant disparities. Social determinants of health including financial access, language barriers, and the presence of a healthy living donor play a role in mediating these disparities. Further investigation is needed to better understand and intervene upon modifiable social, biological, and cultural factors driving the remaining disparity in transplant outcomes.
Asunto(s)
Disparidades en Atención de Salud , Trasplante de Riñón , Listas de Espera , Humanos , Trasplante de Riñón/estadística & datos numéricos , Niño , Disparidades en Atención de Salud/estadística & datos numéricos , Adolescente , Adulto Joven , Donadores Vivos/provisión & distribución , Obtención de Tejidos y Órganos/estadística & datos numéricos , Supervivencia de Injerto , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Fallo Renal Crónico/cirugía , Fallo Renal Crónico/etnología , Fallo Renal Crónico/terapiaRESUMEN
Disparities exist in the access to living donor liver transplantation (LDLT) in the United States. However, the association of neighborhood-level social determinants of health (SDoH) on the receipt of LDLT is not well-established. This was a retrospective cohort study of adult liver transplant recipients between January 1, 2005 and December 31, 2021 at centers performing LDLT using the United Network for Organ Sharing database, which was linked through patients' ZIP code to a set of 24 neighborhood-level SDoH measures from different data sources. Temporal trends and center differences in neighborhood Social Deprivation Index (SDI), a validated scale of socioeconomic deprivation ranging from 0 to 100 (0=least disadvantaged), were assessed by transplant type. Multivariable logistic regression evaluated the association of increasing SDI on receipt of LDLT [vs. deceased donor liver transplantation (DDLT)]. There were 51,721 DDLT and 4026 LDLT recipients at 59 LDLT-performing centers during the study period. Of the 24 neighborhood-level SDoH measures studied, the SDI was most different between the 2 transplant types, with LDLT recipients having lower SDI (ie, less socioeconomic disadvantage) than DDLT recipients (median SDI 37 vs. 47; p < 0.001). The median difference in SDI between the LDLT and DDLT groups significantly decreased from 13 in 2005 to 3 in 2021 ( p = 0.003). In the final model, the SDI quintile was independently associated with transplant type ( p < 0.001) with a threshold SDI of ~40, above which increasing SDI was significantly associated with reduced odds of LDLT (vs. reference SDI 1-20). As a neighborhood-level SDoH measure, SDI is useful for evaluating disparities in the context of LDLT. Center outreach efforts that aim to reduce disparities in LDLT could preferentially target US ZIP codes with SDI > 40.
Asunto(s)
Disparidades en Atención de Salud , Trasplante de Hígado , Donadores Vivos , Determinantes Sociales de la Salud , Humanos , Trasplante de Hígado/estadística & datos numéricos , Donadores Vivos/estadística & datos numéricos , Donadores Vivos/provisión & distribución , Estados Unidos , Femenino , Masculino , Estudios Retrospectivos , Persona de Mediana Edad , Determinantes Sociales de la Salud/estadística & datos numéricos , Disparidades en Atención de Salud/estadística & datos numéricos , Adulto , Características del Vecindario/estadística & datos numéricos , Anciano , Características de la Residencia/estadística & datos numéricos , Obtención de Tejidos y Órganos/estadística & datos numéricos , Enfermedad Hepática en Estado Terminal/cirugía , Enfermedad Hepática en Estado Terminal/diagnóstico , Factores Socioeconómicos , Accesibilidad a los Servicios de Salud/estadística & datos numéricosRESUMEN
BACKGROUND: Living donor liver transplantation (LDLT) continues to be the primary modality of liver transplantation in Asia, but it accounts for about 5% of all liver transplantations in the US. ABO incompatibility is the primary reason motivated donors are declined. Although kidney paired exchanges are common, liver paired exchange (LPE) is still evolving in the US. STUDY DESIGN: This is a retrospective review (between January 1, 2019, and July 31, 2021) of our initial experience with LPE. RESULTS: A total of 10 LPEs (20 LDLTs) were performed during the study period. Seven LPEs were initiated by a nondirected O donor. The other 3 pair sets involved 1 ABO compatible and 1 ABO incompatible pair. Transplantations in a pair set were completed within a mean of 4.8 (range 1-14) days of each other. All 20 donors are doing well with no major complications at 12.7 (range 1-20) months. Seventeen of 20 recipients are alive and have good allograft function. One recipient died in the early postoperative period. Two late deaths of patients with functioning allografts were due to COVID-19 (at 8 months) and peritoneal carcinomatosis and gram-negative sepsis (at 9 months). CONCLUSIONS: LPE is feasible in a high-volume LDLT center and is a useful option to increase LDLT by overcoming ABO incompatibility. Nondirected donors can be utilized to initiate an LPE.
Asunto(s)
Trasplante de Hígado/estadística & datos numéricos , Donadores Vivos/estadística & datos numéricos , Obtención de Tejidos y Órganos/métodos , Sistema del Grupo Sanguíneo ABO , Adolescente , Adulto , Anciano , Incompatibilidad de Grupos Sanguíneos , COVID-19/mortalidad , Causas de Muerte , Femenino , Humanos , Riñón , Donadores Vivos/provisión & distribución , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Estudios Retrospectivos , Obtención de Tejidos y Órganos/estadística & datos numéricos , Receptores de Trasplantes/estadística & datos numéricos , Adulto JovenRESUMEN
The purpose of this study is to highlight the need and the obligation to combine living donation with deceased one, this later is an incomparable source of organ donation, a plea with a triple objective: 1) analyzing the contribution of living donations in terms of numbers, through two elements: the degree of involvement of our medico-surgical competencies and our regulations governing organ donations. 2) Showing that, even though optimized, living donations will always fall short of the needs of our patients and are only part of the solution. 3) The other part is deceased donors: a source of donation which can not be substituted by that of the living donors, and which concerns patients awaiting a vital organ with no possibility of another substitute treatment. Patients are sentenced to death if not transplanted in a few weeks. In this respect, only professionalism and full staff availability can rid us of prejudices which unjustly and systematically overwhelm our society with regard to this type of life-saving donations. In countries promoting and performing this source of donation, a national priority planning network has been developed. This program ensures reliable results, based on universal standards for ethics, recruitment, training and organization. For health authorities of these same countries, the sharing of these organs with others countries is irrational and unreasonable. As long as these organs remain the only life-saving for this type of seriously ill patients, and this source of grafts will be insufficient to meet the needs of all their patients.
Asunto(s)
Donadores Vivos/provisión & distribución , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos/estadística & datos numéricos , Argelia , Humanos , Trasplante de Órganos/métodosAsunto(s)
Prestación Integrada de Atención de Salud , Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado , Donantes de Tejidos/provisión & distribución , Obtención de Tejidos y Órganos , Adulto , Anciano , Prestación Integrada de Atención de Salud/economía , Prestación Integrada de Atención de Salud/organización & administración , Enfermedad Hepática en Estado Terminal/diagnóstico , Enfermedad Hepática en Estado Terminal/economía , Enfermedad Hepática en Estado Terminal/epidemiología , Femenino , Costos de la Atención en Salud , Humanos , Cooperación Internacional , Kuwait/epidemiología , Trasplante de Hígado/economía , Donadores Vivos/provisión & distribución , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Obtención de Tejidos y Órganos/economía , Obtención de Tejidos y Órganos/organización & administraciónAsunto(s)
Trasplante de Hígado/tendencias , Evaluación de Procesos y Resultados en Atención de Salud/tendencias , Donantes de Tejidos/provisión & distribución , Adulto , Anciano , Femenino , Supervivencia de Injerto , Humanos , Trasplante de Hígado/efectos adversos , Donadores Vivos/provisión & distribución , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/etiología , Evaluación de Programas y Proyectos de Salud , Factores de Tiempo , Resultado del Tratamiento , Emiratos Árabes Unidos , Adulto JovenAsunto(s)
Seguro de Salud/legislación & jurisprudencia , Donadores Vivos/legislación & jurisprudencia , Obtención de Tejidos y Órganos/legislación & jurisprudencia , Humanos , Seguro de Salud/economía , Donadores Vivos/provisión & distribución , Obtención de Tejidos y Órganos/economía , Estados UnidosAsunto(s)
Trasplante de Riñón , Donadores Vivos/provisión & distribución , Turismo Médico , Insuficiencia Renal Crónica/cirugía , Obtención de Tejidos y Órganos , República Democrática del Congo/epidemiología , Humanos , Inmunosupresores/uso terapéutico , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/epidemiología , Resultado del TratamientoRESUMEN
BACKGROUND: Living-donor lobar lung transplantation (LDLLT) is viable for critically ill patients in situations of donor shortage. Because it is sometimes difficult to find 2 ideal living donors with suitable graft sizes, we developed native lung-sparing procedures, including single LDLLT and native upper lobe-sparing LDLLT. This study aimed to investigate native lung complications (NLCs) in native lung-sparing LDLLT. METHODS: Between April 2002 and March 2019, 92 LDLLTs and 124 cadaveric lung transplantations (CLTs) were performed at the Kyoto University Hospital. Our prospectively maintained database and clinical records were reviewed to compare NLCs among recipients who underwent native lung-sparing LDLLT (nâ¯=â¯21) with those among recipients who underwent single CLT (nâ¯=â¯61). RESULTS: Among 21 recipients who underwent native lung-sparing LDLLT, 11 NLCs occurred in 8 recipients. No fatal NLC was noted; however, 2 required surgical intervention. Post-transplant survival was not significantly different between native lung-sparing LDLLT recipients with NLCs and those without NLCs. The incidence of NLCs was comparable between native lung-sparing LDLLT recipients and single CLT recipients (8/21 vs 26/61, pâ¯=â¯0.80); however, NLCs occurred significantly later in LDLLT recipients than in CLT recipients (median: 665 vs 181.5 days after transplantation, pâ¯=â¯0.014). CONCLUSIONS: NLCs after native lung-sparing LDLLT had favorable outcomes. Therefore, native lung-sparing LDLLT is a useful treatment option for severely ill patients who cannot wait for CLT. However, it is important to recognize that NLCs may occur later in LDLLT than in CLT.
Asunto(s)
Donadores Vivos/provisión & distribución , Trasplante de Pulmón/efectos adversos , Complicaciones Posoperatorias/epidemiología , Adolescente , Adulto , Niño , Femenino , Supervivencia de Injerto , Humanos , Incidencia , Trasplante de Pulmón/métodos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Resultado del Tratamiento , Adulto JovenRESUMEN
BACKGROUND: Share 35 was a policy implemented in 2013 to increase regional sharing of deceased donor livers to patients with model for end-stage liver disease ≥ 35 to decrease waitlist mortality for the sickest patients awaiting liver transplantation (LT). The purpose of this study was to determine whether live donor liver transplantation (LDLT) volume was impacted by the shift in allocation of deceased donor livers to patients with higher model for end-stage liver disease scores. METHODS: Using Network for Organ Sharing/Organ Procurement and Transplantation Network Standard Transplant Analysis and Research files, we identified all adults who received a primary LT between October 1, 2008, and March 31, 2018. LT from October 1, 2008, through June 30, 2013, was designated as the pre-Share 35 era and July 1, 2013, through March 31, 2018, as the post-Share 35 era. Primary outcomes included transplant volumes, graft survival, and patient survival in both eras. RESULTS: In total, 48 779 primary adult single-organ LT occurred during the study period (22 255 pre-Share 35, 26 524 post). LDLT increased significantly (6.8% post versus 5.7% pre, P < 0.001). LDLT volume varied significantly by region (P < 0.001) with regions 2, 4, 5, and 8 demonstrating significant increases in LDLT volume post-Share 35. The number of centers performing LDLT increased only in regions 4, 6, and 11. Throughout the 2 eras, there was no difference in graft or patient survival for LDLT recipients. CONCLUSIONS: Overall, LDLT volume increased following the implementation of Share 35, which was largely due to increased LDLT volume at centers with experience in LDLT, and corresponded to significant geographic variation in LDLT utilization.
Asunto(s)
Técnicas de Apoyo para la Decisión , Selección de Donante , Enfermedad Hepática en Estado Terminal/cirugía , Trasplante de Hígado , Donadores Vivos/provisión & distribución , Enfermedad Hepática en Estado Terminal/diagnóstico , Femenino , Humanos , Trasplante de Hígado/efectos adversos , Masculino , Persona de Mediana Edad , Valor Predictivo de las Pruebas , Medición de Riesgo , Factores de Riesgo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento , Estados UnidosRESUMEN
BACKGROUND: Long-term studies have demonstrated a slight increased risk for end-stage renal disease (ESRD) for living kidney donors (LKD). In France, living kidney donation doubled within the past 10 years. We investigated the change in characteristics of LKD between 2007 and 2017 and the adequacy of follow-up. METHODS: Data were obtained from the national registry for LKD. We compared characteristics of LKD between two study periods: 2007-11 and 2012-17, and stratified donors by age and relation to recipient. We aggregated four characteristics associated with higher ESRD risk [young age, first-degree relation to recipient, obesity, low glomerular filtration rate (GFR) for age] in a single risk indicator ranging from 0 to 4. RESULTS: We included 3483 donors. The proportion of unrelated donors >56 years of age increased significantly. The proportion of related donors <56 years of age decreased significantly. The body mass index and proportion of obese donors did not change significantly. The proportion of donors with low estimated GFR for age decreased significantly from 5% to 2.2% (P < 0.001). The proportion of donors with adequate follow-up after donation increased from 19.6% to 42.5% (P < 0.001). No donor had a risk indicator equal to 4, and the proportion of donors with a risk indicator equal to 0 increased significantly from 19.2% to 24.9% (P < 0.001). CONCLUSIONS: An increase in living kidney donation in France does not seem to be associated with the selection of donors at higher risk of ESRD and the proportion of donors with adequate annual follow-up significantly increased.