目的:报告终末期肾病(ESRD)患者和肾移植患者的流行病学和特征,并评估获得等待名单和肾移植结果。
方法:在Medline数据库(http://www.ncbi.nlm.nih.gov)和Embase(http://www.embase.com)使用以下关键字的不同关联:“慢性肾病,流行病学,肾移植,成本,生存,移植,脑死亡,心脏骤停,access,分配\"。法国法律文件已通过政府门户网站(http://www。法国军团.gouv.fr).根据方法选择文章,出版语言和相关性。参考列表用于确定感兴趣的其他历史研究。前瞻性和回顾性系列,法语和英语,以及评论文章和建议被选中。此外,法国国家移植和卫生机构(http://www。agence-biomedecine。fr和http://www。has-sante.fr)数据库使用相同的关键字进行筛选。共3234条,确定了6份官方报告和3份报纸文章;经过精心挑选,99份出版物符合我们的审查条件。
结果:慢性肾脏病(CKD)患病率的增加导致器官短缺恶化。肾移植仍然是ESRD的最佳治疗选择。为接受者提供更高的生存率和生活质量,成本低于其他肾脏替代疗法。等待名单的无休止延长引发了有关治疗策略和候选人选择的问题,并强调了器官共享的局限性,而没有可用于移植的额外肾脏来源。
结论:分配政策旨在减少在等待名单或获得同种异体移植方面的医疗或地理差异。
OBJECTIVE: To report epidemiology and characteristics of end-stage renal disease (ESRD) patients and renal transplant candidates, and to evaluate access to waiting list and results of renal transplantation.
METHODS: An exhaustive systematic review of the scientific literature was performed in the Medline database (http://www.ncbi.nlm.nih.gov) and Embase (http://www.embase.com) using different associations of the following keywords: \"chronic kidney disease, epidemiology, kidney transplantation, cost, survival, graft, brain death, cardiac arrest, access, allocation\". French legal documents have been reviewed using the government portal (http://www.legifrance.gouv.fr). Articles were selected according to methods, language of publication and relevance. The reference lists were used to identify additional historical studies of interest. Both prospective and retrospective series, in French and English, as well as review articles and recommendations were selected. In addition, French national transplant and health agencies (http://www.agence-biomedecine.fr and http://www.has-sante.fr) databases were screened using identical keywords. A total of 3234 articles, 6 official reports and 3 newspaper articles were identified; after careful selection 99 publications were eligible for our review.
RESULTS: The increasing prevalence of chronic kidney disease (CKD) leads to worsen organ shortage. Renal transplantation remains the best treatment option for ESRD, providing recipients with an increased survival and quality of life, at lower costs than other renal replacement therapies. The never-ending lengthening of the waiting list raises issues regarding treatment strategies and candidates\' selection, and underlines the limits of organ sharing without additional source of kidneys available for transplantation.
CONCLUSIONS: Allocation policies aim to reduce medical or geographical disparities regarding enrollment on a waiting list or access to an allotransplant.