G.S. Rosenblatt, N. Nakamura, J.M. Barry

目的：尽管很多研究都指出肾脏捐赠中供体的发病风险和死亡风险很低，但是当供体为器官移植而进行脏器捐赠时，我们必须谨记此时的供体是有危险的。有报告指出在不同的随访时间内，肾脏捐赠者出现终末期肾病（ESRD）的概率为0.2%至0.5%。在此，我们报道了本中心4名发生ESRD的活体肾脏捐赠者。

材料和方法：我们回顾性分析了1959年10月1日至2005年6月30日期间在本中心进行肾脏切除的捐赠者的入院资料和医疗记录，尤其是术后发生ESRD的捐赠者。

结果：在1959年10月1日至2005年6月底期间，本中心共进行了3591例肾脏移植手术，其中1195例的移植脏器（33%）来源于活体捐赠者，捐赠者的平均年龄为41.9岁。4名肾脏捐赠者（0.33%）术后出现了ESRD，他们捐赠时的平均年龄为31岁，发生ESRD的平均年龄为46.5岁。这4名供体的捐赠对象均为患有肾功能衰竭的兄弟姐妹。其中2名供体（50%）还有其他一级亲缘关系的亲属发生肾功能衰竭，2名供体（50%）在捐赠手术之后抽烟，1名供体（25%）肥胖。

结论：活体肾脏捐赠者进展到ESRD是罕见的。在严格的准入资格下进行的肾脏捐赠是安全的。有肾脏病家族病史的捐赠者发展为ESRD的风险会有所增加。

End-Stage Renal Disease After Kidney Donation: A Single-Center Experience
G.S. Rosenblatt, N. Nakamura, J.M. Barry

Purpose: Although the risk of kidney donation has been determined in many studies to be low with respect to morbidity and mortality, it is important to keep in mind that patients are put at some risk when they donate an organ for transplantation. The reported incidence of end-stage renal disease (ESRD) among kidney donors ranges from 0.2% to 0.5% with varying follow-up times. Herein, we have reported four living kidney donors at our institution who progressed to ESRD.

Materials and Methods: We reviewed registry data and medical records of patients who underwent donor nephrectomy at our institution between October 1, 1959, and June 30, 2005, particularly cases who developed ESRD.

Results: Between October, 1959, and the end of June, 2005, 3591 kidney transplants were performed at our center including 1195 of the organs (33%) from living donors, whose mean age was 41.9 years. Four kidney donors (0.33%) developed ESRD. Their mean age at donation was 31 years; the mean age at ESRD development was 46.5 years. All four patients donated to siblings with renal failure. Two of the four (50%) had another first-degree relative who subsequently developed renal failure. Two of the four (50%) smoked tobacco subsequent to donor surgery, and one (25%) was obese.

Conclusions: Progression to ESRD is rare among living renal donors. Kidney donation is safe when strict eligibility criteria are met. There may be an increased risk for progression to ESRD among donors with a family history of renal disease.

Volume 40, Issue 5, Pages 1315-1318 (June 2008)

[责任编辑:刘 聪]