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

50 年以上活体肾脏捐赠者的结果与来自同一地理区域的健康匹配的同期非捐赠者队列的比较

基本信息

批准号：
10619612
负责人：
ARTHUR J MATAS
金额：
$ 62.05万
依托单位：
UNIVERSITY OF MINNESOTA
依托单位国家：
美国
项目类别：
财政年份：
2020
资助国家：
美国
起止时间：
2020-07-01 至 2025-04-30
项目状态：
未结题

项目摘要

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.

抽象的对于有资格的末期肾脏疾病（ESRD）的符合条件的患者，生物供体（LD）肾脏移植是最好的选项。但是LD必须进行大型手术，并具有外科手术风险和潜在的长期生活风险有一个肾脏。许多研究与年龄，性别和种族/种族匹配的LD进行比较一般人群控制措施发现LDS和对照之间的长期结局没有差异。但是，最近将LD与健康匹配对照进行比较的研究报告说，LDS处于 ESRD和死亡的风险增加。在这些中，人们一直担心LD和控件的匹配包括匹配对照在内的研究不是同时发生的[同年出生的]；不是来自相同的地理区域；众所周知，在与捐赠日期相匹配的日期不健康；是不符合ESRD的家族史。这些因素中的每一个都会影响肾脏疾病的风险和肾脏疾病的后果。有限的后续行动和统计这些研究的分析。实际上，一些评论表明，LD风险被低估了。其他人高估了。对真实长期LD风险有完整，准确的了解很重要提供数据以告知未来LD候选人（知情同意），并为长期设计提供信息捐助者的健康维持/监视。政府机构，其他利益相关者和LDS本身是要求提供更好的LD结果的长期数据。明尼苏达大学（明尼苏达州立大学）和梅奥诊所有长期的LD移植计划（1963年第一次移植），数据收集开始于第一次移植的时间。此外，1960年代初期的罗切斯特流行病学项目（REP）建立了一个链接的医疗记录系统，该系统遵循了Olmsted居民的病史县及周边地区（地理与MN和Mayo诊所相同）。代表的数据已经用于提供有关健康人群的长期数据，并且已经采用了确定健康匹配的方法来自代表的控件。我们将与年龄，性别，种族/种族的同时代代表对照相匹配以及已知影响肾脏疾病风险的其他重要特征（例如BMI，吸烟史，血液压力）。我们还将匹配LDS和对照在健康之日健康（具有正常肾功能）的控制捐赠和肾脏疾病家族史。由于详细的长期（> 50年的随访） LD和REP数据集中的质量数据，我们将能够学习并提供迄今为止的最佳数据：LD风险 ESRD和死亡；在ESRD或死亡之前发生更常见的中间事件的LD风险（例如，肾功能，心血管疾病的恶化）； BMI或吸烟等已知危险因素的影响关于捐款的风险；捐赠后新发作疾病（例如糖尿病，高血压）对LD的影响结果；以及捐赠对随后怀孕的影响。我们将提供最全面的数据，迄今为止，要通知潜在的LDS长期风险，并告知当前LDS的随访和护理。

项目成果

期刊论文数量（5）

专著数量（0）

科研奖励数量（0）

会议论文数量（0）

专利数量（0）

Pre-kidney Donation Pregnancy Complications and Long-term Outcomes.

DOI：
10.1097/tp.0000000000004146
发表时间：
2022-10-01
期刊：
Transplantation
影响因子：
6.2
作者：
通讯作者：

The Minnesota attributable risk of kidney donation (MARKD) study: a retrospective cohort study of long-term (> 50 year) outcomes after kidney donation compared to well-matched healthy controls.

DOI：
10.1186/s12882-023-03149-7
发表时间：
2023-05-01
期刊：
BMC NEPHROLOGY
影响因子：
2.3
作者：
Vock, David M.;Helgeson, Erika S.;Mullan, Aidan F.;Issa, Naim S.;Sanka, Sujana;Saiki, Alison C.;Mathson, Kristin;Chamberlain, Alanna M.;Rule, Andrew D.;Matas, Arthur J.
通讯作者：
Matas, Arthur J.

Development and Validation of a Hypertension Risk Calculator for Living Kidney Donors.

活体肾脏捐赠者高血压风险计算器的开发和验证。

DOI：
10.1097/tp.0000000000004505
发表时间：
2023
期刊：
Transplantation
影响因子：
6.2
作者：
Helgeson,ErikaS;Vempati,Shruti;Palzer,EliseF;Mjoen,Geir;Haugen,AndersJ;Matas,ArthurJ
通讯作者：
Matas,ArthurJ

Risk of kidney disease after living kidney donation.