A 12-Year Analysis of Equity and Efficiency in Living Kidney Donation at a Rural American Center

IF 1.9 4区医学 Q2 SURGERY

Clinical Transplantation Pub Date : 2025-09-09 DOI:10.1111/ctr.70315

Benjamin Limburg, Kaleb Dobbs, Els Reuvekamp, Sujit Vijay Sakpal

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引用次数: 0

Abstract

Background

In the United States, a severe organ shortage precipitates an extensive transplant waitlist. Living donor kidneys are functionally superior to those from deceased donors and offer an alternative to close the supply-demand gap.

Methods

A retrospective review of 2147 patients who self-referred to begin the living kidney donation workup process at our center between June 1, 2012, and October 1, 2023 was conducted with subsequent statistical analysis of gathered data. National Kidney Registry (NKR) affiliation began February 1, 2018, and the pre- and post-NKR periods were compared.

Results

The pre-NKR period saw 894 total referrals (42%) compared to 1253 post-NKR (58%). Post-NKR donors increased to 89 from 47 pre-NKR with similar times between stages except for a significantly shorter referral-to-lab review post-NKR (47.0 vs. 56.5 days, p < 0.01). A notable decrease in referrals from Indigenous Peoples was observed (121 [14%] to 93 [7%], p < 0.01) yet donations increased (2 [4%] to 7 [8%], p = 0.042). Donors originating from South Dakota increased (26–54, p = 0.59) post-NKR, and significantly more patients pursued nondirected referral (25 [3%] vs. 173 [14%], p < 0.01) with similar proportions following through with donation. Reasons for dropout during the process were similar between the periods, yet quantitative distributions differed.

Conclusion

NKR affiliation coincided with encouraging results, in many cases similar to broad national trends, attesting to improved connectivity and impact on focal population groups.

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美国农村中心活体肾脏捐献公平与效率的12年分析

在美国，严重的器官短缺导致了大量的移植等待名单。活体捐献者的肾脏在功能上优于已故捐赠者的肾脏，并提供了一种弥补供需缺口的选择。方法回顾性分析2012年6月1日至2023年10月1日在我中心自述开始活体肾脏捐献随访过程的2147例患者，并对收集到的资料进行统计分析。国家肾脏登记处（NKR）隶属关系于2018年2月1日开始，并比较了NKR前后的时期。结果nkr前共转诊894例（42%），而nkr后为1253例（58%）。nkr后的献血者从nkr前的47人增加到89人，除了nkr后转诊到实验室复查的时间明显缩短（47.0天对56.5天，p < 0.01）。来自土著居民的转诊数量显著减少（121[14%]至93 [7%]，p < 0.01），但捐赠数量增加（2[4%]至7 [8%]，p = 0.042）。nkr后，来自南达科他州的献血者增加了（26-54,p = 0.59），并且更多的患者寻求非定向转诊（25 [3%]vs. 173 [14%], p < 0.01）。在这两个时期中，辍学的原因相似，但数量分布不同。在许多情况下与广泛的国家趋势相似，NKR的隶属关系恰逢令人鼓舞的结果，证明了改善的连通性和对重点人群的影响。

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.