Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),...Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis avoidance.There are a number of potential barriers and opportunities to promoting pre-emptive LDKT.Significant infrastructure is needed to deliver robust programmes,which varies based on socio-economic standards.National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes.Focus on other programme’s components,including deceased kidney transplantation and RRT,can also hamper uptake.LDKT programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive transplantation.Health care providers need to be educated to maximize early LDKT referral.Equitable access for varying population groups,without socioeconomic bias,also requires prioritisation.Cultural barriers,including religious influence,also need consideration in developing successful outcomes.In addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up processes.Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake.Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group.We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success.Education regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical status.Pre-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service delivery.To fully embrace preemptive transplantation as the norm,investment in infrastructure,increased awareness,and donor and recipient support is required.展开更多
Background:Living donor kidney transplantations have been performed at Sahlgrenska University Hospital in Gothenburg, Sweden since 1965. In this study we wanted to explore the living kidney donor’s long-term experien...Background:Living donor kidney transplantations have been performed at Sahlgrenska University Hospital in Gothenburg, Sweden since 1965. In this study we wanted to explore the living kidney donor’s long-term experiences of the donation. Methods: Of 1110 consecutive living donors throughout 1965-2005, 823 were available for our questionnaire study. Results:Totally 692 replied to the questionnaire, 65% were females. The most common relation to the recipients was siblings (284), parents (262) and spouses (96). Time since donation was median 15 years (2 - 43). The initiative to donate came from the donors themselves in 69%. The dominating motives for donation were a wish to help, worries about the recipient not receiving a transplant and the knowledge that one could live a normal life with one kidney. The majority of the donors, felt well informed about potential risks both short-term and long-term. Depression post donation was reported by few donors, 2.3% and persisting pain by 4.3%. Comparisons between sibling donors and spouse donors show a significant difference (p Conclusions:Our study shows that the donor population is in good psychosocial health. It is a positive progress that spouses can be living kidney donors - they seem to be the winners.展开更多
文摘Live donor kidney transplantation(LDKT)is the optimal treatment modality for end stage renal disease(ESRD),enhancing patient and graft survival.Pre-emptive LDKT,prior to requirement for renal replacement therapy(RRT),provides further advantages,due to uraemia and dialysis avoidance.There are a number of potential barriers and opportunities to promoting pre-emptive LDKT.Significant infrastructure is needed to deliver robust programmes,which varies based on socio-economic standards.National frameworks can impact on national prioritisation of pre-emptive LDKT and supporting education programmes.Focus on other programme’s components,including deceased kidney transplantation and RRT,can also hamper uptake.LDKT programmes are designed to provide maximal benefit to the recipient,which is specifically true for pre-emptive transplantation.Health care providers need to be educated to maximize early LDKT referral.Equitable access for varying population groups,without socioeconomic bias,also requires prioritisation.Cultural barriers,including religious influence,also need consideration in developing successful outcomes.In addition,the benefit of pre-emptive LDKT needs to be emphasised,and opportunities provided to potential donors,to ensure timely and safe work-up processes.Recipient education and preparation for pre-emptive LDKT needs to ensure increased uptake.Awareness of the benefits of pre-emptive transplantation require prioritisation for this population group.We recommend an approach where patients approaching ESRD are referred early to pre-transplant clinics facilitating early discussion regarding pre-emptive LDKT and potential donors for LDKT are prioritized for work-up to ensure success.Education regarding preemptive LDKT should be the norm for patients approaching ESRD,appropriate for the patient’s cultural needs and physical status.Pre-emptive transplantation maximize benefit to potential recipients,with the potential to occur within successful service delivery.To fully embrace preemptive transplantation as the norm,investment in infrastructure,increased awareness,and donor and recipient support is required.
文摘Background:Living donor kidney transplantations have been performed at Sahlgrenska University Hospital in Gothenburg, Sweden since 1965. In this study we wanted to explore the living kidney donor’s long-term experiences of the donation. Methods: Of 1110 consecutive living donors throughout 1965-2005, 823 were available for our questionnaire study. Results:Totally 692 replied to the questionnaire, 65% were females. The most common relation to the recipients was siblings (284), parents (262) and spouses (96). Time since donation was median 15 years (2 - 43). The initiative to donate came from the donors themselves in 69%. The dominating motives for donation were a wish to help, worries about the recipient not receiving a transplant and the knowledge that one could live a normal life with one kidney. The majority of the donors, felt well informed about potential risks both short-term and long-term. Depression post donation was reported by few donors, 2.3% and persisting pain by 4.3%. Comparisons between sibling donors and spouse donors show a significant difference (p Conclusions:Our study shows that the donor population is in good psychosocial health. It is a positive progress that spouses can be living kidney donors - they seem to be the winners.
