Determining Predictors of Actual Living Kidney Donation Based on Potential Donor Characteristics

IF 1.9 4区医学 Q2 SURGERY Clinical Transplantation Pub Date : 2024-08-27 DOI:10.1111/ctr.15439

Andrea M. Meinders, Edward A. Graviss, Duc T. Nguyen, Jonathan Daw, Krista L. Lentine, John Devin Peipert, Ahmed Osama Gaber, David A. Axelrod, Francis L. Weng, Amy D. Waterman

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Abstract

Background

Living donor kidney transplantation is the optimal treatment for end-stage kidney disease; however, few living donor candidates (LDCs) who begin evaluation actually donate. While some LDCs are deemed medically ineligible, others discontinue for potentially modifiable reasons.

Methods

At five transplant centers, we conducted a prospective cohort study measuring LDCs’ clinical and psychosocial characteristics, educational preparation, readiness to donate, and social determinants of health. We followed LDCs for 12 months after evaluation to determine whether they donated a kidney, opted to discontinue, had modifiable reasons for discontinuing, were medically ineligible, or had other recipient-related reasons for discontinuing.

Results

Among 2184 LDCs, 18.6% donated, 38.2% opted to or had modifiable reasons for discontinuing, and 43.2% were deemed ineligible due to medical or recipient-related reasons. Multivariable analyses comparing successful LDCs with those who did not complete donation for modifiable reasons (N = 1241) found that LDCs who discussed donation with the recipient before evaluation (OR, 2.31; 95% CI, 1.54–3.46), had completed high school (OR, 2.01; 95% CI, 1.21–3.35), or were a “close relation” to their recipient (OR, 1.89; 95% CI, 1.33–2.69) were more likely to donate. Conversely, LDCs who reported religion as important (OR, 0.55; 95% CI, 0.38–0.80), were Non-White (OR, 0.70; 95% CI, 0.49–1.00), or had overall higher anxiety scores (OR, 0.92; 95% CI, 0.86–0.99) were less likely to donate.

Conclusion

With fewer than a fifth of LDCs donating, developing programs to provide greater emotional support and facilitate open discussions between LDCs and recipients earlier may increase living donation rates.

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根据潜在捐献者的特征确定实际活体肾脏捐献的预测因素。

背景：活体肾移植是治疗终末期肾病的最佳方法；然而，开始评估的活体肾移植候选者（LDC）中，真正捐献者寥寥无几。有些活体捐献者在医学上被认为不符合捐献条件，有些则因潜在的可改变原因而中止捐献：我们在五个移植中心开展了一项前瞻性队列研究，测量 LDC 的临床和社会心理特征、教育准备情况、捐献准备情况以及健康的社会决定因素。我们在评估后对 LDC 进行了为期 12 个月的跟踪调查，以确定他们是否捐献了肾脏、是否选择中止捐献、中止捐献的原因是否可以改变、是否不符合医疗条件或是否有其他与受者相关的中止捐献原因：在 2184 名当地捐献者中，18.6% 的人捐献了肾脏，38.2% 的人选择停止捐献或有可改变的原因而停止捐献，43.2% 的人因医疗或与受捐者相关的原因而被认为不符合捐献条件。将成功捐赠的 LDC 与因可修改原因而未完成捐赠的 LDC（N = 1241）进行多变量分析后发现，在评估前与受捐者讨论过捐赠事宜（OR，2.31；95% CI，1.54-3.46）、已完成高中学业（OR，2.01；95% CI，1.21-3.35）或与受捐者 "关系密切"（OR，1.89；95% CI，1.33-2.69）的 LDC 更有可能捐赠。相反，认为宗教很重要（OR，0.55；95% CI，0.38-0.80）、非白人（OR，0.70；95% CI，0.49-1.00）或总体焦虑评分较高（OR，0.92；95% CI，0.86-0.99）的最不发达国家捐赠的可能性较低：结论：由于只有不到五分之一的遗体捐献者进行了捐献，因此制定相关计划，为遗体捐献者和受捐者提供更多的情感支持并促进他们尽早进行公开讨论，可能会提高活体捐献率。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Transplantation 医学-外科

CiteScore

3.70

自引率

4.80%

发文量

286

审稿时长

2 months

期刊介绍： Clinical Transplantation: The Journal of Clinical and Translational Research aims to serve as a channel of rapid communication for all those involved in the care of patients who require, or have had, organ or tissue transplants, including: kidney, intestine, liver, pancreas, islets, heart, heart valves, lung, bone marrow, cornea, skin, bone, and cartilage, viable or stored. Published monthly, Clinical Transplantation’s scope is focused on the complete spectrum of present transplant therapies, as well as also those that are experimental or may become possible in future. Topics include: Immunology and immunosuppression; Patient preparation; Social, ethical, and psychological issues; Complications, short- and long-term results; Artificial organs; Donation and preservation of organ and tissue; Translational studies; Advances in tissue typing; Updates on transplant pathology;. Clinical and translational studies are particularly welcome, as well as focused reviews. Full-length papers and short communications are invited. Clinical reviews are encouraged, as well as seminal papers in basic science which might lead to immediate clinical application. Prominence is regularly given to the results of cooperative surveys conducted by the organ and tissue transplant registries. Clinical Transplantation: The Journal of Clinical and Translational Research is essential reading for clinicians and researchers in the diverse field of transplantation: surgeons; clinical immunologists; cryobiologists; hematologists; gastroenterologists; hepatologists; pulmonologists; nephrologists; cardiologists; and endocrinologists. It will also be of interest to sociologists, psychologists, research workers, and to all health professionals whose combined efforts will improve the prognosis of transplant recipients.