A potential living kidney donor with prediabetes

Recommendations for living donor kidney transplantation

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes. Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor. Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations. This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors' health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors. Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

Utilization of HbA1c in Screening Living Kidney Donors With Prediabetes

OBJECTIVES

To study the outcome of living kidney donors with prediabetes and to evaluate the utilization of baseline HbA1c to identify donors at high risk for developing diabetes during the postdonation follow-up period.

PATIENTS AND METHODS

Living kidney donors with prospectively collected preoperative fasting glucose and HbA1c results were included in the study. Donors were categorized to the high-risk group when both results were in the prediabetic range, the low-risk group when only 1 result was in the prediabetic range, and the control group when both results were normal.

RESULTS

Ninety-three donors were followed for 75.9 ± 23.3 months. A higher proportion of donors in the high-risk group progressed to diabetes compared with donors in the low-risk and control groups (31.3% vs 6.5% vs 0.0%, respectively; P < .001). Donors with prediabetes were not at a higher risk for new-onset hypertension (4.4% vs 10.0% vs 7.7%, in control, low-risk, and high-risk groups, respectively; P = .519) or microproteinuria (7.3% vs 10.3% vs 0.0%, in control, low-risk, and high-risk groups, respectively; P = .478) and exhibited equivalent postdonation renal function compared with donors with normal glucose metabolism.

CONCLUSIONS

HbA1c can identify donors with prediabetes who are at risk for progression to diabetes. Our results indicate that carefully accepted donors with prediabetes are not at increased risk of renal function deterioration in the immediate postdonation period.