Download PDF
CC BY-NC-ND 4.0 · Avicenna J Med 2021; 11(04): 172-184
DOI: 10.1055/s-0041-1736541
Original Article

Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy

Ziad Arabi
1   Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
,
Muhammad Bukhari 
2   Department of Medicine, Division of Adult Nephrology, Taif University, Taif, Saudi Arabia
,
Abdullah Hamad 
3   Department of Medicine, Division of Nephrology, Regional Medical Center of Orangeburg and Calhoun Counties, Orangeburg, South Carolina, United States
,
Abdulrahman Altheaby 
1   Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
,
Saleh Kaysi
4   Department of Medicine, Division of Nephrology, CHU, Clermont-Ferrand, France
› Author Affiliations
› Further Information
   Permissions and Reprints

Abstract

Background To assess the practice patterns of the acceptance of medically complex living kidney donors (MCLKDs).

Methods We distributed a survey to nephrologists and transplant surgeons (TS) across the world through major international transplant societies. The survey contained questions regarding obesity, abnormal blood glucose profile, mild hypertension, donor-recipient age discrepancy, or family history of kidney disease of unknown etiology.

Results In total, 239 respondents from 29 countries (42% were nephrologists and 58% were TS).

Most respondents would allow donations from obese donors, especially if they intended to lose weight but would be cautious if these donors had abnormal blood glucose or family history of diabetes mellitus. In hypertensive donors, future pregnancy plans mattered in decisions regarding the acceptance of female donors. Most respondents would allow young donors but would be more cautious if they had a future risk of hypertension or a family history of kidney disease of unknown etiology. They would also allow donations from an older person if prolonged waiting time was anticipated. We found multiple areas of consensus of practice among the diverse members of international transplant societies, with some interesting variations among nephrologists and TS.

Conclusions This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with these conditions.

Keywords

Age - Diabetes - Extended criteria - Family history of kidney disease - Gender - Hypertension - Living kidney donor - Metabolic syndrome - Obesity - Pregnancy - Survey

Disclosure

The authors declare no conflicts of interest.


Financial Support

None.




Publication History

Article published online:
15 November 2021

© 2021. Syrian American Medical Society. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Maggiore U, Cravedi P. The marginal kidney donor. Curr Opin Organ Transplant 2014; 19 (04) 372-380
    CrossrefPubMedGoogle Scholar
  • 2 Reese PP, Feldman HI, McBride MA, Anderson K, Asch DA, Bloom RD. Substantial variation in the acceptance of medically complex live kidney donors across US renal transplant centers. Am J Transplant 2008; 8 (10) 2062-2070
    CrossrefPubMedGoogle Scholar
  • 3 Maggiore U, Budde K, Heemann U. et al; ERA-EDTA DESCARTES working group. Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group. Nephrol Dial Transplant 2017; 32 (02) 216-223
    CrossrefPubMedGoogle Scholar
  • 4 Muzaale AD, Massie AB, Wang M-C. et al. Risk of end-stage renal disease following live kidney donation. JAMA 2014; 311 (06) 579-586
    CrossrefPubMedGoogle Scholar
  • 5 Halverson CME, Wang JY, Poulson M, Karlin J, Crowley-Matoka M, Ross LF. Living kidney donors who develop kidney failure: excerpts of their thoughts. Am J Nephrol 2016; 43 (06) 389-396
    CrossrefPubMedGoogle Scholar
  • 6 Kiberd BA, Tennankore KK. Lifetime risks of kidney donation: a medical decision analysis. BMJ Open 2017; 7 (08) e016490
    CrossrefPubMedGoogle Scholar
  • 7 Abramowicz D, Cochat P. et al. The European Renal Best Practice Transplantation guideline development g, Guideline. Nephrol Dial Transplant 2013; 28 (Suppl. 02) ii1-ii71
    CrossrefPubMedGoogle Scholar
  • 8 Lentine KL, Kasiske BL, Levey AS. et al. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101 (8S, Suppl 1) S1-S109
    CrossrefPubMedGoogle Scholar
  • 9 Abramowicz D, Cochat P, Claas FHJ. et al. European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant 2015; 30 (11) 1790-1797
    CrossrefPubMedGoogle Scholar
  • 10 ESRD Risk Tool for Kidney Donor Candidates. Accessed September 16, 2021 at: http://wwwtransplantmodelscom/esrdrisk/
  • 11 Grams ME, Sang Y, Levey AS. et al; Chronic Kidney Disease Prognosis Consortium. Kidney-failure risk projection for the living kidney-donor candidate. N Engl J Med 2016; 374 (05) 411-421
    CrossrefPubMedGoogle Scholar
  • 12 Figurek A, Luyckx VA, Mueller TF. A systematic review of renal functional reserve in adult living kidney donors. Kidney Int Rep 2020; 5 (04) 448-458
    CrossrefPubMedGoogle Scholar
  • 13 Cantarelli C, Cravedi P. Criteria for living donation from marginal donors: one, no one, and one hundred thousand. Nephron 2019; 142 (03) 227-232
    CrossrefPubMedGoogle Scholar
  • 14 Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF. Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation. PLoS One 2017; 12 (07) e0181846
    CrossrefPubMedGoogle Scholar
  • 15 Garg N, Lentine KL, Inker LA. et al. Metabolic, cardiovascular, and substance use evaluation of living kidney donor candidates: US practices in 2017. Am J Transplant 2020; 20 (12) 3390-3400
    CrossrefPubMedGoogle Scholar
  • 16 Garg AX, Levey AS, Kasiske BL, Cheung M, Lentine KL. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors Work Group and Evidence Review Team. Application of the 2017 KDIGO Guideline for the Evaluation and Care of Living Kidney Donors to Clinical Practice. Clin J Am Soc Nephrol 2020; 15 (06) 896-905
    CrossrefPubMedGoogle Scholar
  • 17 Prevention CfDC. Defining Adult Overweight and Obesity. Accessed April 14, 2020 at: https://wwwcdcgov/obesity/adult/defininghtml
    Google Scholar
  • 18 Europe WROf. Body mass index. Accessed September 16, 2021 at: http://wwweurowhoint/en/health-topics/disease-prevention/nutrition/a-healthy-lifestyle/body-mass-index-bmi
    Google Scholar
  • 19 Ganz ML, Wintfeld N, Li Q, Alas V, Langer J, Hammer M. The association of body mass index with the risk of type 2 diabetes: a case-control study nested in an electronic health records system in the United States. Diabetol Metab Syndr 2014; 6 (01) 50
    CrossrefPubMedGoogle Scholar
  • 20 Gray N, Picone G, Sloan F, Yashkin A. Relation between BMI and diabetes mellitus and its complications among US older adults. South Med J 2015; 108 (01) 29-36
    CrossrefPubMedGoogle Scholar
  • 21 Praga M, Hernández E, Herrero JC. et al. Influence of obesity on the appearance of proteinuria and renal insufficiency after unilateral nephrectomy. Kidney Int 2000; 58 (05) 2111-2118
    CrossrefPubMedGoogle Scholar
  • 22 Hsu CY, McCulloch CE, Iribarren C, Darbinian J, Go AS. Body mass index and risk for end-stage renal disease. Ann Intern Med 2006; 144 (01) 21-28
    CrossrefPubMedGoogle Scholar
  • 23 Taner T, Iqbal CW, Textor SC, Stegall MD, Ishitani MB. Compensatory hypertrophy of the remaining kidney in medically complex living kidney donors over the long term. Transplantation 2015; 99 (03) 555-559
    CrossrefPubMedGoogle Scholar
  • 24 Tavakol MM, Vincenti FG, Assadi H. et al. Long-term renal function and cardiovascular disease risk in obese kidney donors. Clin J Am Soc Nephrol 2009; 4 (07) 1230-1238
    CrossrefPubMedGoogle Scholar
  • 25 Taler S. The Obese Kidney Donor Living Donor Community of Practice of AST. Accessed September 16, 2021 at: https://www.myast.org/sites/default/files/pdf/Chapter%205%20%20The%20obese%20donor.pdf
    Google Scholar
  • 26 Scott RA, Langenberg C, Sharp SJ. et al; InterAct Consortium. The link between family history and risk of type 2 diabetes is not explained by anthropometric, lifestyle or genetic risk factors: the EPIC-InterAct study. Diabetologia 2013; 56 (01) 60-69
    CrossrefPubMedGoogle Scholar
  • 27 Garg N, Lentine KL, Inker LA. et al. The kidney evaluation of living kidney donor candidates: US practices in 2017. Am J Transplant 2020
    Google Scholar
  • 28 Jacobs SC, Cho E, Dunkin BJ. et al. Laparoscopic nephrectomy in the markedly obese living renal donor. Urology 2000; 56 (06) 926-929
    CrossrefPubMedGoogle Scholar
  • 29 Lentine KL, Lam NN, Axelrod D. et al. Perioperative complications after living kidney donation: a national study. Am J Transplant 2016; 16 (06) 1848-1857
    CrossrefPubMedGoogle Scholar
  • 30 Reese PP, Feldman HI, Asch DA, Thomasson A, Shults J, Bloom RD. Short-term outcomes for obese live kidney donors and their recipients. Transplantation 2009; 88 (05) 662-671
    CrossrefPubMedGoogle Scholar
  • 31 Heimbach JK, Taler SJ, Prieto M. et al. Obesity in living kidney donors: clinical characteristics and outcomes in the era of laparoscopic donor nephrectomy. Am J Transplant 2005; 5 (05) 1057-1064
    CrossrefPubMedGoogle Scholar
  • 32 Mandelbrot DA, Pavlakis M, Danovitch GM. et al. The medical evaluation of living kidney donors: a survey of US transplant centers. Am J Transplant 2007; 7 (10) 2333-2343
    CrossrefPubMedGoogle Scholar
  • 33 American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care 2013; 36 (Suppl. 01) S67-S74
    CrossrefPubMedGoogle Scholar
  • 34 Kumar R, Nandhini LP, Kamalanathan S, Sahoo J, Vivekanadan M. Evidence for current diagnostic criteria of diabetes mellitus. World J Diabetes 2016; 7 (17) 396-405
    CrossrefPubMedGoogle Scholar
  • 35 Kim D-L, Kim S-D, Kim SK, Park S, Song K-H. Is an oral glucose tolerance test still valid for diagnosing diabetes mellitus?. Diabetes Metab J 2016; 40 (02) 118-128
    CrossrefPubMedGoogle Scholar
  • 36 Lee J, Lee YA, Kim JH, Lee SY, Shin CH, Yang SW. Discrepancies between glycosylated hemoglobin and fasting plasma glucose for diagnosing impaired fasting glucose and diabetes mellitus in Korean youth and young adults. Diabetes Metab J 2019; 43 (02) 174-182
    CrossrefPubMedGoogle Scholar
  • 37 Yu EYT, Wong CKH, Ho SY, Wong SYS, Lam CLK. Can HbA1c replace OGTT for the diagnosis of diabetes mellitus among Chinese patients with impaired fasting glucose?. Fam Pract 2015; 32 (06) 631-638
    PubMedGoogle Scholar
  • 38 Nguyen MJP, Carpenter D, Tadros J. et al. Bariatric surgery prior to living donor nephrectomy: a solution to expand the living donor kidney pool - a retrospective study. Transpl Int 2019; 32 (07) 702-709
    CrossrefPubMedGoogle Scholar
  • 39 Brooks J, Mitro G, Deleonibus A. et al. Bariatric surgery for obese live kidney donors: an analysis of risks and benefits. Integr Obes Diabetes 2017; (e-pub ahead of print) DOI: 10.15761/IOD.1000186.
    CrossrefGoogle Scholar
  • 40 Andrews PA, Burnapp L. British Transplantation Society / Renal Association UK Guidelines for Living Donor Kidney Transplantation 2018: Summary of Updated Guidance. Transplantation 2018; 102 (07) e307
    CrossrefPubMedGoogle Scholar
  • 41 Ierino F, Boudville N, Kanellis J. CARI. The CARI guidelines. Donors at risk: hypertension. Nephrology (Carlton) 2010; 15 (Suppl. 01) S114-S120
    CrossrefPubMedGoogle Scholar
  • 42 Garg AX, Nevis IF, McArthur E. et al; DONOR Network. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med 2015; 372 (02) 124-133
    CrossrefPubMedGoogle Scholar
  • 43 Boudville N, Prasad GV, Knoll G. et al; Donor Nephrectomy Outcomes Research (DONOR) Network. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med 2006; 145 (03) 185-196
    CrossrefPubMedGoogle Scholar
  • 44 Holscher CM, Bae S, Thomas AG. et al. Early hypertension and diabetes after living kidney donation: a national cohort study. Transplantation 2019; 103 (06) 1216-1223
    CrossrefPubMedGoogle Scholar
  • 45 Sanchez OA, Ferrara LK, Rein S, Berglund D, Matas AJ, Ibrahim HN. Hypertension after kidney donation: incidence, predictors, and correlates. Am J Transplant 2018; 18 (10) 2534-2543
    CrossrefPubMedGoogle Scholar
  • 46 Holscher CM, Haugen CE, Jackson KR. et al. Self-reported incident hypertension and long-term kidney function in living kidney donors compared with healthy nondonors. Clin J Am Soc Nephrol 2019; 14 (10) 1493-1499
    CrossrefPubMedGoogle Scholar
  • 47 Mjøen G, Hallan S, Hartmann A. et al. Long-term risks for kidney donors. Kidney Int 2014; 86 (01) 162-167
    CrossrefPubMedGoogle Scholar
  • 48 Steiner RW, Ix JH, Rifkin DE, Gert B. Estimating risks of de novo kidney diseases after living kidney donation. Am J Transplant 2014; 14 (03) 538-544
    CrossrefPubMedGoogle Scholar
  • 49 Pioli MR, Ritter AM, de Faria AP, Modolo R. White coat syndrome and its variations: differences and clinical impact. Integr Blood Press Control 2018; 11: 73-79
    CrossrefPubMedGoogle Scholar
  • 50 Staessen JA, Thijs L, Fagard R. et al; Systolic Hypertension in Europe Trial Investigators. Predicting cardiovascular risk using conventional vs ambulatory blood pressure in older patients with systolic hypertension. JAMA 1999; 282 (06) 539-546
    CrossrefPubMedGoogle Scholar
  • 51 Campbell M, Wright L, Greenberg RA, Grant D. How young is too young to be a living donor?. Am J Transplant 2013; 13 (07) 1643-1649
    CrossrefPubMedGoogle Scholar
  • 52 Kher A, Mandelbrot DA. The living kidney donor evaluation: focus on renal issues. Clin J Am Soc Nephrol 2012; 7 (02) 366-371
    CrossrefPubMedGoogle Scholar
  • 53 Karim A, Farrugia D, Cheshire J. et al. Recipient age and risk for mortality after kidney transplantation in England. Transplantation 2014; 97 (08) 832-838
    CrossrefPubMedGoogle Scholar
  • 54 Huang E, Segev DL, Rabb H. Kidney transplantation in the elderly. Semin Nephrol 2009; 29 (06) 621-635
    CrossrefPubMedGoogle Scholar
  • 55 Calabuig AS, Martínez EG, Berga JK. et al. Kidney transplantation in recipients older than 70 years old: a good option for our patients. Transplantation 2018; 102: S468
    CrossrefGoogle Scholar
  • 56 Segall L, Nistor I, Pascual J. et al. Criteria for and appropriateness of renal transplantation in elderly patients with end-stage renal disease: a literature review and position statement on behalf of the European Renal Association-European Dialysis and Transplant Association Descartes Working Group and European Renal Best Practice. Transplantation 2016; 100 (10) e55-e65
    CrossrefPubMedGoogle Scholar
  • 57 Hart A, Smith JM, Skeans MA. et al. Kidney. Am J Transplant 2016; 16 (Suppl. 02) 11-46
    CrossrefPubMedGoogle Scholar
  • 58 Nadkarni GN, Gignoux CR, Sorokin EP. et al. Worldwide Frequencies of APOL1 Renal Risk Variants. N Engl J Med 2018; 379 (26) 2571-2572
    CrossrefPubMedGoogle Scholar
  • 59 Parsa A, Kao WH, Xie D. et al; AASK Study Investigators; CRIC Study Investigators. APOL1 risk variants, race, and progression of chronic kidney disease. N Engl J Med 2013; 369 (23) 2183-2196
    CrossrefPubMedGoogle Scholar
  • 60 Devuyst O. Genetic variants and risk of chronic kidney disease. Perit Dial Int 2014; 34 (02) 150-150
    CrossrefPubMedGoogle Scholar
  • 61 Mohan S, Iltis AS, Sawinski D, DuBois JM. APOL1 genetic testing in living kidney transplant donors. Am J Kidney Dis 2019; 74 (04) 538-543
    CrossrefPubMedGoogle Scholar
  • 62 Thomas CP, Mansilla MA, Sompallae R. et al. Screening of living kidney donors for genetic diseases using a comprehensive genetic testing strategy. Am J Transplant 2017; 17 (02) 401-410
    CrossrefPubMedGoogle Scholar
  • 63 Corredor Z, Filho MIDS, Rodríguez-Ribera L. et al. Genetic variants associated with chronic kidney disease in a Spanish population. Sci Rep 2020; 10 (01) 144
    CrossrefPubMedGoogle Scholar
  • 64 Cañadas-Garre M, Anderson K, Cappa R. et al. Genetic susceptibility to chronic kidney disease - Some more pieces for the heritability puzzle. Front Genet 2019; 10 (453) 453
    CrossrefPubMedGoogle Scholar
  • 65 Skrunes R, Svarstad E, Reisæter AV, Vikse BE. Familial clustering of ESRD in the Norwegian population. Clin J Am Soc Nephrol 2014; 9 (10) 1692-1700
    CrossrefPubMedGoogle Scholar