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活体肾脏供者的评估及供肾切除的风险

Authors
Krista L Lentine, MD, PhD
Anitha Vijayan, MD
John Vella, MD, FACP, FRCP, FASN
Section Editor
Daniel C Brennan, MD, FACP
Deputy Editor
Alice M Sheridan, MD
Translators
朱同玉, 主任医师，教授

引言

美国等待肾移植的患者数量不断稳步增加，尽管采取增加非标准死亡供者移植肾使用的措施，但移植肾的供需差仍在扩大。虽然可采用增加活体供者器官的使用来满足移植需求，但过去10年的活体肾脏捐赠率并没有增加，事实上，捐赠率从2004年到2014年下降了17%[1]。该趋势的主要原因是活体亲缘捐赠减少，虽然自2007年以来交换捐赠及其他非亲属捐赠(如非指定捐赠)的数量有所上升，但仍不足以弥补活体亲缘捐赠的减少[2]。

和死亡供者的器官相比，活体供者器官具有显著的移植物存活优势。此外，活体供者移植的过程中可能很少发生延误且能控制时间安排，因此可行无透析移植(即在透析之前进行移植)或在受者肾功能衰竭的早期就进行移植。 (参见“肾移植中移植物失功的危险因素”和“肾移植前后的透析问题”)

评判供者和受者之间生物相容性的主要标准是血型和交叉配型的相容度。除了人类白细胞抗原(human leukocyte antigen, HLA)相同的双胞胎，在现代免疫抑制方案的背景下，生物相容供者与生物不相容供者的同种异体移植物存活率只存在极小差异。应告知生物不相容的供受者双方可以选择供者交换以及不相容的处理规程，并应说明相关风险和益处[3]。 (参见“活体非亲缘供者肾移植”)

2013年2月，美国器官获取和移植网络(Organ Procurement and Transplantation Network, OPTN)对美国所有为活体肾供者取肾的医院下达了政策要求，旨在促进活体供者知情同意、医疗和社会心理评估以及随访的一致性[4]。2014年里，活体供者的全球政策中纳入了这些要求，其中包括一般要求和针对肾脏的要求。这些政策提出的是最低要求，各中心应根据自身经验和患者的具体情况将其扩展成自己的具体规程。

本专题将讨论对潜在活体肾脏供者的评估，包括OPTN的要求。肾移植受者的评估将单独讨论。 (参见“肾移植潜在受者的评估”)

                              

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Literature review current through: 2017-06 . | This topic last updated: 2016-03-14.
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