1
|
Savoye E, Santin G, Legeai C, Kerbaul F, Gaillard F, Pastural M. Comparison of Kidney Graft Function and Survival in an Emulated Trial With Living Donors and Brain-Dead Donors. Transpl Int 2024; 37:13208. [PMID: 39267619 PMCID: PMC11391114 DOI: 10.3389/ti.2024.13208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 07/25/2024] [Indexed: 09/15/2024]
Abstract
Living donation (LD) transplantation is the preferred treatment for kidney failure as compared to donation after brain death (DBD), but age may play a role. We compared the 1-year estimated glomerular filtration rate (eGFR) after kidney transplantation for recipients of LD and DBD stratified by recipient and donor age between 2015 and 2018 in a matched cohort. The strength of the association between donation type and 1-year eGFR differed by recipient age (P interaction < 0.0001). For LD recipients aged 40-54 years versus same-aged DBD recipients, the adjusted odds ratio (aOR) for eGFR ≥60 mL/min/1.73 m2 was 1.48 (95% CI: 1.16-1.90). For DBD recipients aged ≥ 60 years, the aOR was 0.18 (95% CI: 0.12-0.29) versus DBD recipients aged 40-54 years but was 0.91 (95% CI: 0.67-1.24) versus LD recipients aged ≥60 years. In the matched cohort, 4-year graft and patient survival differed by donor age and type. As compared with DBD grafts, LD grafts increased the proportion of recipients with 1-year eGFR ≥60 mL/min/1.73 m2. Recipients aged ≥60 years benefited most from LD transplantation, even if the donor was aged ≥60 years. For younger recipients, large age differences between donor and recipient could also be addressed with a paired exchange program.
Collapse
Affiliation(s)
- Emilie Savoye
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Gaëlle Santin
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - Camille Legeai
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - François Kerbaul
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| | - François Gaillard
- Service de Transplantation, Néphrologie et Immunologie Clinique, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Myriam Pastural
- Direction Prélèvement Greffe Organes-Tissus, Agence de la Biomédecine, Saint-Denis La Plaine, France
| |
Collapse
|
2
|
Gadelkareem RA, Abdelgawad AM, Mohammed N, Zarzour MA, Khalil M, Reda A, Hammouda HM. Challenges to establishing and maintaining kidney transplantation programs in developing countries: What are the coping strategies? World J Methodol 2024; 14:91626. [PMID: 38983660 PMCID: PMC11229866 DOI: 10.5662/wjm.v14.i2.91626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 01/31/2024] [Accepted: 03/12/2024] [Indexed: 06/13/2024] Open
Abstract
Kidney transplantation (KT) is the optimal form of renal replacement therapy for patients with end-stage renal diseases. However, this health service is not available to all patients, especially in developing countries. The deceased donor KT programs are mostly absent, and the living donor KT centers are scarce. Single-center studies presenting experiences from developing countries usually report a variety of challenges. This review addresses these challenges and the opposing strategies by reviewing the single-center experiences of developing countries. The financial challenges hamper the infrastructural and material availability, coverage of transplant costs, and qualification of medical personnel. The sociocultural challenges influence organ donation, equity of beneficence, and regular follow-up work. Low interests and motives for transplantation may result from high medicolegal responsibilities in KT practice, intense potential psychosocial burdens, complex qualification protocols, and low productivity or compensation for KT practice. Low medical literacy about KT advantages is prevalent among clinicians, patients, and the public. The inefficient organizational and regulatory oversight is translated into inefficient healthcare systems, absent national KT programs and registries, uncoordinated job descriptions and qualification protocols, uncoordinated on-site investigations with regulatory constraints, and the prevalence of commercial KT practices. These challenges resulted in noticeable differences between KT services in developed and developing countries. The coping strategies can be summarized in two main mechanisms: The first mechanism is maximizing the available resources by increasing the rates of living kidney donation, promoting the expertise of medical personnel, reducing material consumption, and supporting the establishment and maintenance of KT programs. The latter warrants the expansion of the public sector and the elimination of non-ethical KT practices. The second mechanism is recruiting external resources, including financial, experience, and training agreements.
Collapse
Affiliation(s)
- Rabea Ahmed Gadelkareem
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Amr Mostafa Abdelgawad
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Nasreldin Mohammed
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mohammed Ali Zarzour
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Mahmoud Khalil
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Ahmed Reda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| | - Hisham Mokhtar Hammouda
- Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
| |
Collapse
|
3
|
Ashwin A, Cherukuri SD, Rammohan A. The psychology, legality, ethics and medical aspects of organ donation by minors. Transplant Rev (Orlando) 2024; 38:100832. [PMID: 38340552 DOI: 10.1016/j.trre.2024.100832] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/12/2024]
Abstract
Any individual who has not attained the chronological age of legal majority as per national law is termed a minor. The concept of living donation (LD) has always been a subject of ethical debate and further compounding the controversy is the question of LD by minors. The decision for a minor to donate poses a special challenge as it involves a close family unit of parent-child relationship. Such an emotionally loaded situation wherein questions of attachment, perceived duties, moral obligation are likely to cloud a truly informed consent on the part of the minor to donation, who may find themselves in a vulnerable position. Furthermore, a minor's cognitive ability to comprehend the gravity of LD and when required defy parental coercion need to be elucidates before a minor is accepted for LD. Experts have set out stringent conditions which need to be met prior to the exceptional circumstance that a minor is considered for organ donation. Such donations should require parental permission, child's assent and the involvement of a paediatric-trained donor advocacy team. This article debates the question of minors acting as live donors from ethical, medical, psychosocial and legal viewpoints with an aim to present internationally defined circumstances when a minor may morally participate as a LD, thereby laying the foundation for future deliberations in this regard using traditional metrics to juxtapose divergent courses of action.
Collapse
Affiliation(s)
- A Ashwin
- Wellington School, Wellington, UK
| | | | - A Rammohan
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India.
| |
Collapse
|
4
|
Steiner RW, Glannon W. How the websites of high-volume US centers address the risks of living kidney donation. Clin Transplant 2023; 37:e15054. [PMID: 37395741 DOI: 10.1111/ctr.15054] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 06/06/2023] [Accepted: 06/10/2023] [Indexed: 07/04/2023]
Abstract
BACKGROUND The websites of US transplant centers may be a source of information about the renal risks of potential living kidney donors. METHODS To include only likely best practices, we surveyed websites of centers that performed at least 50 living donor kidney transplants per year. We tabulated how risks were conveyed regarding loss of eGFR at donation, the adequacy of long-term ESRD risk data, long-term donor mortality, minority donor ESRD risk, concerns about hyperfiltration injury versus the risk of end-stage kidney diseases, comparisons of ESRD risks in donors to population risks, the increased risks of younger donors, an effect of the donation itself to increase risk, quantifying risks over specific intervals, and a lengthening list of small post-donation medical risks and metabolic changes of uncertain significance. RESULTS While websites had no formal obligation to address donor risks, many offered abundant information. Some conveyed OPTN-mandated requirements for counseling individual donor candidates. While actual wording often varied, there was general agreement on many issues. We occasionally noted clear-cut differences among websites in risk characterization and other outliers. CONCLUSIONS The websites of the most active US centers offer insights into how transplant professionals view living kidney donor risk. Website content may merit further study.
Collapse
Affiliation(s)
- Robert W Steiner
- UCSD Center for Transplantation and Division of Nephrology, University of California at San Diego School of Medicine, San Diego, California, USA
| | - Walter Glannon
- Department of Philosophy, University of Calgary, Alberta, Canada
| |
Collapse
|
5
|
Vock DM, Helgeson ES, Mullan AF, Issa NS, Sanka S, Saiki AC, Mathson K, Chamberlain AM, Rule AD, Matas AJ. The Minnesota attributable risk of kidney donation (MARKD) study: a retrospective cohort study of long-term (> 50 year) outcomes after kidney donation compared to well-matched healthy controls. BMC Nephrol 2023; 24:121. [PMID: 37127560 PMCID: PMC10152793 DOI: 10.1186/s12882-023-03149-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND There is uncertainty about the long-term risks of living kidney donation. Well-designed studies with controls well-matched on risk factors for kidney disease are needed to understand the attributable risks of kidney donation. METHODS The goal of the Minnesota Attributable Risk of Kidney Donation (MARKD) study is to compare the long-term (> 50 years) outcomes of living donors (LDs) to contemporary and geographically similar controls that are well-matched on health status. University of Minnesota (n = 4022; 1st transplant: 1963) and Mayo Clinic LDs (n = 3035; 1st transplant: 1963) will be matched to Rochester Epidemiology Project (REP) controls (approximately 4 controls to 1 donor) on the basis of age, sex, and race/ethnicity. The REP controls are a well-defined population, with detailed medical record data linked between all providers in Olmsted and surrounding counties, that come from the same geographic region and era (early 1960s to present) as the donors. Controls will be carefully selected to have health status acceptable for donation on the index date (date their matched donor donated). Further refinement of the control group will include confirmed kidney health (e.g., normal serum creatinine and/or no proteinuria) and matching (on index date) of body mass index, smoking history, family history of chronic kidney disease, and blood pressure. Outcomes will be ascertained from national registries (National Death Index and United States Renal Data System) and a new survey administered to both donors and controls; the data will be supplemented by prior surveys and medical record review of donors and REP controls. The outcomes to be compared are all-cause mortality, end-stage kidney disease, cardiovascular disease and mortality, estimated glomerular filtration rate (eGFR) trajectory and chronic kidney disease, pregnancy risks, and development of diseases that frequently lead to chronic kidney disease (e.g. hypertension, diabetes, and obesity). We will additionally evaluate whether the risk of donation differs based on baseline characteristics. DISCUSSION Our study will provide a comprehensive assessment of long-term living donor risk to inform candidate living donors, and to inform the follow-up and care of current living donors.
Collapse
Affiliation(s)
- David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200, Minneapolis, MN, 55414, USA
| | - Erika S Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200, Minneapolis, MN, 55414, USA.
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Naim S Issa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sujana Sanka
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alison C Saiki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Kristin Mathson
- Surgery Clinical Trials Office, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew D Rule
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| |
Collapse
|
6
|
Frutos MÁ, Crespo M, Valentín MDLO, Alonso-Melgar Á, Alonso J, Fernández C, García-Erauzkin G, González E, González-Rinne AM, Guirado L, Gutiérrez-Dalmau A, Huguet J, Moral JLLD, Musquera M, Paredes D, Redondo D, Revuelta I, Hofstadt CJVD, Alcaraz A, Alonso-Hernández Á, Alonso M, Bernabeu P, Bernal G, Breda A, Cabello M, Caro-Oleas JL, Cid J, Diekmann F, Espinosa L, Facundo C, García M, Gil-Vernet S, Lozano M, Mahillo B, Martínez MJ, Miranda B, Oppenheimer F, Palou E, Pérez-Saez MJ, Peri L, Rodríguez O, Santiago C, Tabernero G, Hernández D, Domínguez-Gil B, Pascual J. Recommendations for living donor kidney transplantation. Nefrologia 2022; 42 Suppl 2:5-132. [PMID: 36503720 DOI: 10.1016/j.nefroe.2022.07.001] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 10/26/2021] [Indexed: 06/17/2023] Open
Abstract
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.
Collapse
Affiliation(s)
| | - Marta Crespo
- Nephrology Department, Hospital del Mar, Barcelona, Spain
| | | | | | - Juana Alonso
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | | | - Esther González
- Nephrology Department, Hospital Universitario 12 Octubre, Spain
| | | | - Lluis Guirado
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | - Jorge Huguet
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | | | - Mireia Musquera
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | - David Paredes
- Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Ignacio Revuelta
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Antonio Alcaraz
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | - Manuel Alonso
- Regional Transplantation Coordination, Seville, Spain
| | | | - Gabriel Bernal
- Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain
| | - Alberto Breda
- RT Surgical Team, Fundació Puigvert, Barcelona, Spain
| | - Mercedes Cabello
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Joan Cid
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Fritz Diekmann
- Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain
| | - Laura Espinosa
- Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain
| | - Carme Facundo
- Nephrology Department, Fundacio Puigvert, Barcelona, Spain
| | | | | | - Miquel Lozano
- Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | | | - Eduard Palou
- Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain
| | | | - Lluis Peri
- Urology Department, Hospital Clinic Universitari, Barcelona, Spain
| | | | | | | | - Domingo Hernández
- Nephrology Department, Hospital Regional Universitario de Málaga, Spain
| | | | - Julio Pascual
- Nephrology Department, Hospital del Mar, Barcelona, Spain.
| |
Collapse
|
7
|
Matas AJ, Rule AD. Long-term Medical Outcomes of Living Kidney Donors. Mayo Clin Proc 2022; 97:2107-2122. [PMID: 36216599 PMCID: PMC9747133 DOI: 10.1016/j.mayocp.2022.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022]
Abstract
Historically, to minimize risks, living kidney donors have been highly selected and healthy. Operative risks are well-defined, yet concern remains about long-term risks. In the general population, even a mild reduction in glomerular filtration rate (GFR) is associated with cardiovascular disease, chronic kidney disease, and end-stage kidney disease (ESKD). However, reduction in GFR in the general population is due to kidney or systemic disease. Retrospective studies comparing donors with matched general population controls have found no increased donor risk. Prospective studies comparing donors with controls (maximum follow-up, 9 years) have reported that donor GFR is stable or increases slightly, whereas GFR decreases in controls. However, these same studies identified metabolic and vascular donor abnormalities. There are a few retrospective studies comparing donors with controls. Each has limitations in selection of the control group, statistical analyses, and/or length of follow-up. One such study reported increased donor mortality; 2 reported a small increase in absolute risk of ESKD. Risk factors for donor ESKD are similar to those in the general population. Postdonation pregnancies are also associated with increased risk of hypertension and preeclampsia. There is a critical need for long-term follow-up studies comparing donors with controls from the same era, geographic area, and socioeconomic status who are healthy, with normal renal function on the date matching the date of donation, and are matched on demographic characteristics with the donors. These data are needed to optimize donor candidate counseling and informed consent.
Collapse
Affiliation(s)
- Arthur J Matas
- Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| |
Collapse
|
8
|
Okidi O, Sharma V, Piscoran O, Biggins F, Singh R, Augustine T. The altruistic elderly, a valuable but unrecognised kidney donor group. A case report of an 85-year-old unspecified kidney donor. BMC Geriatr 2022; 22:826. [PMID: 36303107 PMCID: PMC9615365 DOI: 10.1186/s12877-022-03511-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 10/08/2022] [Indexed: 11/27/2022] Open
Abstract
Background Kidney transplantation is the definitive treatment for end stage renal disease (ESRD), offering improved quality of life and survival benefit over remaining on dialysis. There is, however, a prevailing significant mismatch between patients awaiting transplantation and available donor kidneys. Over time, initial stringent donor criteria have broadened and organs from extended criteria donors (ECDs) and older donors are now being accepted for transplantation. The spectrum of living donors has also undergone a change from close family members to an increasingly non-related, non-directed altruistic donors, newly classified as ‘unspecified’ donors. Unspecified elderly donors could be a potential untapped resource to expanding the kidney donor pool globally. Case Presentation We present a case of an 85 year and 8 months old individual, who donated to an unrelated non-directed matched recipient in the national deceased donor transplant waiting list with excellent donor and recipient outcomes at 7 years. Conclusion To our knowledge she is one of the oldest reported unspecified living kidney donors in the world to date. This case illustrates that elderly donors in good health can come forward to donate, knowing that it is safe and valuable. Once the immediate perioperative challenges after kidney donation are managed, elderly donors rarely encounter long term sequelae. We therefore report this case to increase awareness and refocus attention of transplant teams on elderly donors as a potential untapped group to help address the organ shortage problem in renal transplantation.
Collapse
Affiliation(s)
- Okechukwu Okidi
- The Manchester Centre for Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK. .,Abdominal Organ Transplantation, Houston Methodist Hospital, Houston, TX, 77030, USA.
| | - Videha Sharma
- The Manchester Centre for Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Oana Piscoran
- The Manchester Centre for Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Fiona Biggins
- Department of Renal Medicine, Lancashire Teaching Hospitals NHS Foundation Trust, Preston, UK
| | - Rajinder Singh
- The Manchester Centre for Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK
| | - Titus Augustine
- The Manchester Centre for Transplantation, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.,Division of Diabetes, Endocrinology and Gastroenterology, Faculty of Medicine, Biology and Health, University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| |
Collapse
|
9
|
Ebert N, Bevc S, Bökenkamp A, Gaillard F, Hornum M, Jager KJ, Mariat C, Eriksen BO, Palsson R, Rule AD, van Londen M, White C, Schaeffner E. Assessment of kidney function: clinical indications for measured GFR. Clin Kidney J 2021; 14:1861-1870. [PMID: 34345408 PMCID: PMC8323140 DOI: 10.1093/ckj/sfab042] [Citation(s) in RCA: 47] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Indexed: 12/18/2022] Open
Abstract
In the vast majority of cases, glomerular filtration rate (GFR) is estimated using serum creatinine, which is highly influenced by age, sex, muscle mass, body composition, severe chronic illness and many other factors. This often leads to misclassification of patients or potentially puts patients at risk for inappropriate clinical decisions. Possible solutions are the use of cystatin C as an alternative endogenous marker or performing direct measurement of GFR using an exogenous marker such as iohexol. The purpose of this review is to highlight clinical scenarios and conditions such as extreme body composition, Black race, disagreement between creatinine- and cystatin C-based estimated GFR (eGFR), drug dosing, liver cirrhosis, advanced chronic kidney disease and the transition to kidney replacement therapy, non-kidney solid organ transplant recipients and living kidney donors where creatinine-based GFR estimation may be invalid. In contrast to the majority of literature on measured GFR (mGFR), this review does not include aspects of mGFR for research or public health settings but aims to reach practicing clinicians and raise their understanding of the substantial limitations of creatinine. While including cystatin C as a renal biomarker in GFR estimating equations has been shown to increase the accuracy of the GFR estimate, there are also limitations to eGFR based on cystatin C alone or the combination of creatinine and cystatin C in the clinical scenarios described above that can be overcome by measuring GFR with an exogenous marker. We acknowledge that mGFR is not readily available in many centres but hope that this review will highlight and promote the expansion of kidney function diagnostics using standardized mGFR procedures as an important milestone towards more accurate and personalized medicine.
Collapse
Affiliation(s)
- Natalie Ebert
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Sebastjan Bevc
- Department of Nephrology, Faculty of Medicine, Clinic for Internal Medicine, University Medical Center Maribor, University of Maribor, Maribor, Slovenia
| | - Arend Bökenkamp
- Department of Pediatric Nephrology, Amsterdam University Medical Center, Emma Kinderziekenhuis, Amsterdam, The Netherlands
| | - Francois Gaillard
- AP-HP, Hôpital Bichat, Service de Néphrologie, Université de Paris, INSERM U1149, Paris, France
| | - Mads Hornum
- Department of Nephrology, Rigshospitalet and Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Kitty J Jager
- Department of Medical Informatics, ERA-EDTA Registry, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | | | - Bjørn Odvar Eriksen
- Metabolic and Renal Research Group, UiT The Arctic University of Norway, Tromsø, Norway
| | - Runolfur Palsson
- Internal Medicine Services, Division of Nephrology, Landspitali–The National University Hospital of Iceland and Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, Groningen, The Netherlands
| | - Christine White
- Department of Medicine, Division of Nephrology, Queen’s University, Kingston, Canada
| | - Elke Schaeffner
- Institute of Public Health, Charité Universitätsmedizin Berlin, Berlin, Germany
| |
Collapse
|
10
|
Gaillard F, Jacquemont L, Lazareth H, Albano L, Barrou B, Bouvier N, Buchler M, Titeca-Beauport D, Couzi L, Delahousse M, Ducloux D, Etienne I, Frimat L, Garrouste C, Glotz D, Grimbert P, Hazzan M, Hertig A, Hourmant M, Kamar N, Le Meur Y, Le Quintrec M, Legendre C, Moal V, Moulin B, Mousson C, Pouteil-Noble C, Rieu P, Ouali N, Rostaing L, Thierry A, Toure F, Chemouny J, Delanaye P, Courbebaisse M, Mariat C. Living kidney donor evaluation for all candidates with normal estimated GFR for age. Transpl Int 2021; 34:1123-1133. [PMID: 33774875 DOI: 10.1111/tri.13870] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Revised: 03/01/2021] [Accepted: 03/21/2021] [Indexed: 12/01/2022]
Abstract
Multiple days assessments are frequent for the evaluation of candidates to living kidney donation, combined with an early GFR estimation (eGFR). Living kidney donation is questionable when eGFR is <90 ml/min/1.73 m2 (KDIGO guidelines) or 80 ml/min/1.73 m2 (most US centres). However, age-related GFR decline results in a lower eGFR for older candidates. That may limit the number of older kidney donors. Yet, continuing the screening with a GFR measure increases the number of eligible donors. We hypothesized that in-depth screening should be proposed to all candidates with a normal eGFR for age. We compared the evolution of eGFR after donation between three groups of predonation eGFR: normal for age (Sage ) higher than 90 or 80 ml/min/1.73 m2 (S90 and S80, respectively); across three age groups (<45, 45-55, >55 years) in a population of 1825 French living kidney donors with a median follow-up of 5.9 years. In donors younger than 45, postdonation eGFR, absolute- and relative-eGFR variation were not different between the three groups. For older donors, postdonation eGFR was higher in S90 than in S80 or Sage but other comparators were identical. Postdonation eGFR slope was comparable between all groups. Our results are in favour of in-depth screening for all candidates to donation with a normal eGFR for age.
Collapse
Affiliation(s)
- François Gaillard
- Department of Nephrology, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Centre de recherche sur l'inflammation, INSERM UMR1149, CNRS EL8252, Laboratoire d'Excellence Inflamex, Université de Paris, Paris, France
| | - Lola Jacquemont
- Nephrology and Renal Transplantation Department, CHU Nantes, Nantes, France
| | - Hélène Lazareth
- Nephrology Department, Hopital Européen Georges Pompidou, Paris, France
| | - Laetitia Albano
- Nephrology and Renal Transplantation Department, Pasteur Hospital, Nice, France
| | - Benoit Barrou
- Urology Department, Pitié-Salpêtrière, Paris, France
| | - Nicolas Bouvier
- Nephrology, Dialysis, Transplantation Department, CHU Cote de Nacre, Caen University, Caen, France
| | - Mathias Buchler
- Service de Néphrologie et Immunologie Clinique, CHU Tours, Université de Tours, Tours, France
| | | | - Lionel Couzi
- Nephrology, Transplantation and Dialysis, CHU Bordeaux, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| | - Michel Delahousse
- Nephrology, Dialysis and Renal Transplantation Department, Foch Hospital, Suresnes, France
| | - Didier Ducloux
- Nephrology, Dialysis and Transplantation Department, CHU Besançon, Besançon, France
| | | | - Luc Frimat
- Nephrology, Dialysis and Transplantation Department, CHU, Nancy, France
| | - Cyril Garrouste
- Nephrology, Dialysis and Transplantation Department, CHU, Clermont Ferrand, France
| | - Denis Glotz
- Department of Nephrology and Renal Transplantation, Hopital Saint Louis, Paris, France
| | - Philippe Grimbert
- Nephrology and Transplantation Department, UPEC University, Créteil, France
| | - Marc Hazzan
- Nephrology Department, University Hospital, Lille, France
| | - Alexandre Hertig
- Nephrology and Transplantation, Hopital Pitié Salpétrière, Paris, France
| | - Maryvonne Hourmant
- Nephrology and Renal Transplantation Department, CHU Nantes, Nantes, France
| | - Nassim Kamar
- Department of Nephrology, Dialysis and Organ Transplantation, CHU Rangueil, INSERM U1043, IFR-BMT, University Paul Sabatier, Toulouse, France
| | - Yann Le Meur
- Department of Nephrology and Renal Transplantation, CHU Brest, Brest, France
| | - Moglie Le Quintrec
- Nephrology, Transplantation and Dialysis Department, CHU Lapeyronie, and IRMB, INSERM U1183, Montpellier, France
| | - Christophe Legendre
- Nephrology and Renal Transplantation Department, Hopital Necker, Paris, France
| | - Valérie Moal
- Nephrology and Renal Transplantation, APHM, Marseille, France
| | - Bruno Moulin
- Nephrology and Transplantation Department, University Hospital, Strasbourg, France
| | | | - Claire Pouteil-Noble
- Renal Transplantation Department, Hospices Civils de Lyon, Claude Bernard University, Lyon, France
| | - Philippe Rieu
- Nephrology and Renal Transplantation Department, University Hospital, Reims, France
| | - Nacera Ouali
- Nephrology and Renal Transplantation, Hopital Tenon, Paris, France
| | - Lionel Rostaing
- Nephrology, Hemodialysis, Apheresis and Transplantation Department, University Hospital, Grenoble, France
| | - Antoine Thierry
- Nephrology Department, University Hospital and Poitiers University, INSERM U1082, Poitiers, France
| | - Fatouma Toure
- Nephrology, Dialysis and Renal Transplantation Department, CHU, Limoges, France
| | - Jonathan Chemouny
- Nephrology, Dialysis and Transplantation Department, University Hospital, Rennes, France
| | - Pierre Delanaye
- Department of Nephrology-Dialysis-Transplantation, University of Liège (ULg CHU), Liège, Belgium.,Department of Nephrology-Dialysis-Apheresis, Hopital Universitaire Caremeau, Nimes, France
| | - Marie Courbebaisse
- Department of Physiology, European Georges Pompidou Hospital, APHP, INSERM U1151, Paris University, Paris, France
| | - Christophe Mariat
- Nephrology, Dialysis and Renal Transplantation Department, Hôpital Nord, CHU de Saint-Etienne, Jean Monnet University, COMUE Université de Lyon, Lyon, France
| |
Collapse
|
11
|
Dahle DO, Mjøen G. Hypertensive Living Kidney Donor Candidates: What's the Risk? Kidney Int Rep 2021; 6:1208-1210. [PMID: 34015066 PMCID: PMC8116970 DOI: 10.1016/j.ekir.2021.03.891] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 03/16/2021] [Accepted: 03/19/2021] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dag Olav Dahle
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| | - Geir Mjøen
- Department of Transplantation Medicine, Oslo University Hospital, Oslo, Norway
| |
Collapse
|
12
|
Mjøen G, Maggiore U, Kessaris N, Kimenai D, Watschinger B, Mariat C, Sever MS, Crespo M, Peruzzi L, Spasovski G, Sørensen SS, Heemann U, Pascual J, Viklicky O, Courtney AE, Hadaya K, Wagner L, Nistor I, Hadjianastassiou V, Durlik M, Helanterä I, Oberbauer R, Oniscu G, Hilbrands L, Abramowicz D. Long-term risks after kidney donation: how do we inform potential donors? A survey from DESCARTES and EKITA transplantation working groups. Nephrol Dial Transplant 2021; 36:1742-1753. [PMID: 33585931 PMCID: PMC8397510 DOI: 10.1093/ndt/gfab035] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2020] [Indexed: 11/29/2022] Open
Abstract
Background Publications from the last decade have increased knowledge regarding long-term risks after kidney donation. We wanted to perform a survey to assess how transplant professionals in Europe inform potential kidney donors regarding long-term risks. The objectives of the survey were to determine how they inform donors and to what extent, and to evaluate the degree of variation. Methods All transplant professionals involved in the evaluation process were considered eligible, regardless of the type of profession. The survey was dispatched as a link to a web-based survey. The subjects included questions on demographics, the information policy of the respondent and the use of risk calculators, including the difference of relative and absolute risks and how the respondents themselves understood these risks. Results The main finding was a large variation in how often different long-term risks were discussed with the potential donors, i.e. from always to never. Eighty percent of respondents stated that they always discuss the risk of end-stage renal disease, while 56% of respondents stated that they always discuss the risk of preeclampsia. Twenty percent of respondents answered correctly regarding the relationship between absolute and relative risks for rare outcomes. Conclusions The use of written information and checklists should be encouraged. This may improve standardization regarding the information provided to potential living kidney donors in Europe. There is a need for information and education among European transplant professionals regarding long-term risks after kidney donation and how to interpret and present these risks.
Collapse
Affiliation(s)
- Geir Mjøen
- Section of Nephrology, Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Umberto Maggiore
- Department of Medicine and Surgery, University of Parma, Parma, Italy
| | | | - Diederik Kimenai
- Erasmus University Hospital Rotterdam, Rotterdam, The Netherlands
| | - Bruno Watschinger
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | - Cristophe Mariat
- Centre Hospitalier Universitaire de Saint Etienne, Saint Etienne, France
| | | | - Marta Crespo
- Hospital del Mar, Department of Nephrology, Barcelona, Spain
| | | | - Goce Spasovski
- University Clinic of Nephrology, Skopje, North Macedonia
| | | | - Uwe Heemann
- Technische Universität München, München, Germany
| | - Julio Pascual
- Hospital del Mar, Department of Nephrology, Barcelona, Spain
| | - Ondrej Viklicky
- Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | | | | | | | - Ionut Nistor
- Methodological Center for Medical Research and Evidence-Based Medicine, University of Medicine and Pharmacy "Grigore T. Popa", Iasi, Romania
| | - Vassilis Hadjianastassiou
- Renal Unit, Royal London Hospital, Whitechapel, Bart's Health, NHS Trust, London, UK.,University of Nicosia, Nicosia, Cyprus
| | | | | | - Rainer Oberbauer
- Medical University of Vienna, Department of Medicine III, Division of Nephrology and Dialysis, Vienna, Austria
| | | | - Luuk Hilbrands
- Radboud University Medical Center, Nijmegen, The Netherlands
| | | |
Collapse
|
13
|
Bjerre A, Mjøen G, Line PD, Naper C, Reisaeter AV, Åsberg A. Five decades with grandparent donors: The Norwegian strategy and experience. Pediatr Transplant 2020; 24:e13751. [PMID: 32485019 DOI: 10.1111/petr.13751] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2019] [Revised: 04/17/2020] [Accepted: 05/06/2020] [Indexed: 11/29/2022]
Abstract
Living donors (LDs) are preferred over DDs for renal transplantation in children due to superior GS. Oslo University Hospital has never restricted living donation by upper age. The aim of this study was to investigate long-term outcomes using grandparents (GPLD) compared to PLD. Retrospective nationwide review in the period 1970-2017. First renal graft recipients using a GPLD were compared to PLD kidney recipients for long-term renal function and GS. 278 children (≤18 years) received a first renal transplant: 27/251 recipients with a GPLD/PLD. GPLD (median 59 (42-74) years) were significantly older than PLD (median 41 (23-65) years, (P < .001). Median DRAD was 52 (38-70) vs 28 (17-48) years, respectively. GS from GPLD and PLD had a 1-, 5-, and 10-year survival of 100%, 100%, and 90% vs 93%, 82%, and 72%, respectively (P = .6). In a multivariate Cox regression analysis adjusted for gender, donor age, recipient age, and year of transplant, this finding was similar (HR 0.98; 95% CI 0.34-2.84, P = .97). Five-year eGFR was 47.3 and 59.5 mL/min/1.73 m2 in the GPLD and PLD groups (P = .028), respectively. In this nationwide retrospective analysis, GS for pediatric renal recipients using GPLD was comparable to PLD. Renal function assessed as eGFR was lower in the GPLD group. The GPLD group was significantly older than the PLD group, but overall this did not impact transplant outcome. Based on these findings, older age alone should not exclude grandparent donations.
Collapse
Affiliation(s)
- Anna Bjerre
- Department of Pediatrics, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,University of Oslo, Oslo, Norway
| | - Geir Mjøen
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Pål-Dag Line
- University of Oslo, Oslo, Norway.,Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Christian Naper
- Department of Immunology, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anna Varberg Reisaeter
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Anders Åsberg
- Department of Transplantation Medicine, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Norwegian Renal Registry, Oslo University Hospital, Rikshospitalet, Oslo, Norway.,Department of Pharmacy, University of Oslo, Oslo, Norway
| |
Collapse
|
14
|
Abstract
Long-term safety of living kidney donation (LKD), especially for young donors, has become a real matter of concern in the transplant community and may contribute to creating resistance to LKD. In this context, the criteria that govern living donor donations must live up to very demanding standards as well as adjust to this novel reality. In the first part, we review the existing guidelines published after 2010 and critically examine their recommendations to see how they do not necessarily lead to consistent and universal practices in the choice of specific thresholds for a parameter used to accept or reject a living donor candidate. In the second part, we present the emergence of a new paradigm for LKD developed in the 2017 Kidney Disease: Improving Global Outcomes guidelines with the introduction of an integrative risk-based approach. Finally, we focus on predonation renal function evaluation, a criteria that remain central in the selection process, and discuss several issues surrounding the donor candidate's glomerular filtration rate assessment.
Collapse
|
15
|
Haller MC, Wallisch C, Mjøen G, Holdaas H, Dunkler D, Heinze G, Oberbauer R. Predicting donor, recipient and graft survival in living donor kidney transplantation to inform pretransplant counselling: the donor and recipient linked iPREDICTLIVING tool - a retrospective study. Transpl Int 2020; 33:729-739. [PMID: 31970822 PMCID: PMC7383676 DOI: 10.1111/tri.13580] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 10/23/2019] [Accepted: 01/17/2020] [Indexed: 01/02/2023]
Abstract
Although separate prediction models for donors and recipients were previously published, we identified a need to predict outcomes of donor/recipient simultaneously, as they are clearly not independent of each other. We used characteristics from transplantations performed at the Oslo University Hospital from 1854 live donors and from 837 recipients of a live donor kidney transplant to derive Cox models for predicting donor mortality up to 20 years, and recipient death, and graft loss up to 10 years. The models were developed using the multivariable fractional polynomials algorithm optimizing Akaike’s information criterion, and optimism‐corrected performance was assessed. Age, year of donation, smoking status, cholesterol and creatinine were selected to predict donor mortality (C‐statistic of 0.81). Linear predictors for donor mortality served as summary of donor prognosis in recipient models. Age, sex, year of transplantation, dialysis vintage, primary renal disease, cerebrovascular disease, peripheral vascular disease and HLA mismatch were selected to predict recipient mortality (C‐statistic of 0.77). Age, dialysis vintage, linear predictor of donor mortality, HLA mismatch, peripheral vascular disease and heart disease were selected to predict graft loss (C‐statistic of 0.66). Our prediction models inform decision‐making at the time of transplant counselling and are implemented as online calculators.
Collapse
Affiliation(s)
- Maria C Haller
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria.,Nephrology, Ordensklinikum Linz, Elisabethinen, Linz, Austria
| | - Christine Wallisch
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Geir Mjøen
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Hallvard Holdaas
- Department of Transplant Medicine, Oslo University Hospital, Oslo, Norway
| | - Daniela Dunkler
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Georg Heinze
- Section for Clinical Biometrics, Center for Medical Statistics, Informatics and Intelligent Systems (CeMSIIS), Medical University of Vienna, Vienna, Austria
| | - Rainer Oberbauer
- Division of Nephrology and Dialysis, Department of Medicine III, Medical University of Vienna, Vienna, Austria
| |
Collapse
|
16
|
Reed RD, Hites L, Mustian MN, Shelton BA, Hendricks D, Berry B, MacLennan PA, Blackburn J, Wingate MS, Yates C, Hannon L, Kilgore ML, Locke JE. A Qualitative Assessment of the Living Donor Navigator Program to Identify Core Competencies and Promising Practices for Implementation. Prog Transplant 2019; 30:29-37. [DOI: 10.1177/1526924819892919] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023]
Abstract
Introduction: The best strategy to increase awareness of and access to living kidney donation remains unknown. To build upon the existing strategies, we developed the Living Donor Navigator program, combining advocacy training of patient advocates with enhanced health-care systems training of patient navigators to address potential living donor concerns during the evaluation process. Herein, we describe a systematic assessment of the delivery and content of the program through focus group discussion. Methods: We conducted focus groups with 9 advocate participants in the Living Donor Navigator program to identify knowledge, skills, and abilities needed for both advocates and navigators. We focused on 2 organizational levels: (1) the participant level or the advocacy training of the advocates and (2) the programmatic level or the support role provided by the navigators and administration of the program. Findings: From 4 common themes (communication, education, support, and commitment), we identified several core competencies and promising practices, at both the participant and programmatic levels. These themes highlighted the potential for several improvements of program content and delivery, the importance of cultural sensitivity among the Living Donor navigators, and the opportunity for informal caregiver support and accountability provided by the program. Discussion: These competencies and promising practices represent actionable strategies for content refinement, optimal training of advocates, and engagement of potential living donors through the Living Donor Navigator program. These findings may also assist with program implementation at other transplant centers in the future.
Collapse
Affiliation(s)
- Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham, AL, USA
| | - Lisle Hites
- Department of Health Care Organization & Policy, University of Alabama at Birmingham School of Public Health, AL, USA
| | - Margaux N. Mustian
- Comprehensive Transplant Institute, University of Alabama at Birmingham, AL, USA
| | - Brittany A. Shelton
- Comprehensive Transplant Institute, University of Alabama at Birmingham, AL, USA
| | - Daagye Hendricks
- Comprehensive Transplant Institute, University of Alabama at Birmingham, AL, USA
| | - Beverly Berry
- Comprehensive Transplant Institute, University of Alabama at Birmingham, AL, USA
| | - Paul A. MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham, AL, USA
| | - Justin Blackburn
- Department of Health Policy and Management, Indiana University—Purdue University Indianapolis School of Public Health, IN, USA
| | - Martha S. Wingate
- Department of Health Care Organization & Policy, University of Alabama at Birmingham School of Public Health, AL, USA
| | - Clayton Yates
- Department of Biology and Center for Cancer Research, Tuskegee University, AL, USA
| | - Lonnie Hannon
- Department of Biology and Center for Cancer Research, Tuskegee University, AL, USA
| | - Meredith L. Kilgore
- Department of Health Care Organization & Policy, University of Alabama at Birmingham School of Public Health, AL, USA
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham, AL, USA
| |
Collapse
|
17
|
Steiner RW. Amending a historic paradigm for selecting living kidney donors. Am J Transplant 2019; 19:2405-2406. [PMID: 31119848 DOI: 10.1111/ajt.15469] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2019] [Revised: 04/03/2019] [Accepted: 04/22/2019] [Indexed: 01/25/2023]
Affiliation(s)
- Robert W Steiner
- UCSD Center for Transplantation and Division of Nephrology, University of California at San Diego School of Medicine, San Diego, California
| |
Collapse
|
18
|
Khan MT, Hamid R, Ali AS. Long-term health consequences of living kidney donation: From the perspective of donors. SAUDI JOURNAL OF KIDNEY DISEASES AND TRANSPLANTATION 2019; 30:995-997. [PMID: 31464263 DOI: 10.4103/1319-2442.265482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Muhammad Tassaduq Khan
- Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan
| | - Rashid Hamid
- Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan
| | - Akbar Shoukat Ali
- Renal Transplant Unit, National Institute of Solid Organ and Tissue Transplantation, Dow University of Health Sciences, Ojha Campus, Karachi, Pakistan
| |
Collapse
|
19
|
Regarding age-calibrated glomerular filtration rate. Kidney Int 2019; 95:234-235. [PMID: 30606421 DOI: 10.1016/j.kint.2018.10.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2018] [Accepted: 10/04/2018] [Indexed: 11/23/2022]
|
20
|
Steiner RW. "You can't get there from here": Critical obstacles to current estimates of the ESRD risks of young living kidney donors. Am J Transplant 2019; 19:32-36. [PMID: 30137698 DOI: 10.1111/ajt.15089] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2018] [Revised: 07/16/2018] [Accepted: 08/17/2018] [Indexed: 01/25/2023]
Abstract
Short studies that generate lifetime end-stage renal disease (ESRD) risks for young living kidney donors have conflicted with the knowledge and practice of nontransplant specialists. A widely accepted online risk calculator (OLRC) is no exception. It uses 6.4 year observations and an ostensibly empiric methodology to predict low lifetime risks for normal young candidates. But the nonspecific ESRD risk factors identified in this study are likely features of kidney diseases that were already underway at study entry. No practicing nephrologist would use their absence to predict any specific kidney disease that had yet to begin, which is essential for excluding high-risk individuals. The OLRC's risk estimates are particularly low because it also does not assign to young adults about 70% of the lifetime ESRD that they will experience as they age, which is part of their risk. It reinforces traditional concepts of low donor risk, minimizing the potential relevance of recent, sometimes concerning, long-term outcome data. These data suggest many similarities between postdonation ESRD and ESRD in the general population, about which much is already known. Despite our best efforts, the heterogeneity and exponential accumulation of end-stage kidney diseases over time prevent long-term predictions of risk for young kidney donors.
Collapse
Affiliation(s)
- Robert W Steiner
- UCSD Center for Transplantation and Division of Nephrology, University of California at San Diego School of Medicine, San Diego, CA, USA
| |
Collapse
|
21
|
Kulu Y, Fathi P, Golriz M, Khajeh E, Sabagh M, Ghamarnejad O, Mieth M, Ulrich A, Hackert T, Müller-Stich BP, Strobel O, Michalski C, Morath C, Zeier M, Büchler MW, Mehrabi A. Impact of Surgeon's Experience on Vascular and Haemorrhagic Complications After Kidney Transplantation. Eur J Vasc Endovasc Surg 2019; 57:139-149. [DOI: 10.1016/j.ejvs.2018.07.041] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2017] [Accepted: 07/24/2018] [Indexed: 01/09/2023]
|
22
|
Nguyen QL, Merville P, Couzi L. Impact of the individualized risks of end-stage renal disease on living kidney donor selection. Nephrol Dial Transplant 2018; 33:2245-2252. [PMID: 29846692 DOI: 10.1093/ndt/gfy145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Accepted: 04/18/2018] [Indexed: 11/13/2022] Open
Abstract
Background It is recommended to determine the risks of end-stage renal disease (ESRD) in living donor candidates. The aim of this study was to determine how many candidates would have been cleared for donation according to different thresholds of risks. Methods Four pre-donation and post-donation risks of ESRD were calculated retrospectively using online tools (http://www.transplantmodels.com/) and the calculator of the University of Minnesota for 151 living kidney donors and 27 patients disqualified for living donation based on a glomerular filtration rate (GFR) <80 mL/min/1.73 m2. Results A complete overlap of the pre-donation 15-year ESRD risk, pre-donation projected lifetime ESRD risk, post-donation 15-year ESRD risk and the Minnesota post-donation 15-year risk of ESRD or GFR <30 mL/min/1.73 m2 was observed for the living kidney donors and the disqualified candidates. We next defined different thresholds of pre- and post-donation risks of ESRD that could be used for clearing living donation. In candidates over 61 years of age, the use of a pre-donation 15-year ESRD risk of 0.25% and/or a post-donation 15-year ESRD risk of 50 per 10 000 would increase the percentage of donors by 28.6% and 26.3%, respectively. Conversely, only 22.3% of donors aged 18-35 years would have been selected by using a pre-donation projected lifetime ESRD risk <0.5%. Conclusions The use of these ESRD risks would significantly modify donor selection by increasing the percentage of donors ≥61 years of age with GFR <80 mL/min/1.73 m2 and by decreasing the percentage of donors aged 18-35 years with a high GFR.
Collapse
Affiliation(s)
- Quang-Linh Nguyen
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France
| | - Pierre Merville
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,Immuno ConcEpT, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| | - Lionel Couzi
- Department of Nephrology, Transplantation, Dialysis and Apheresis, Bordeaux University Hospital, Bordeaux, France.,Immuno ConcEpT, CNRS UMR 5164, Bordeaux University, Bordeaux, France
| |
Collapse
|
23
|
Mjoen G, Abramowicz D. What happens to the live donor in the years following donation? Nephrol Dial Transplant 2018. [DOI: 10.1093/ndt/gfy356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Geir Mjoen
- Division of Medicine, Department of Nephrology, Oslo University Hospital, Ullevål, Oslo, Norway
| | - Daniel Abramowicz
- Department of Nephrology, Universitair Ziekenhuis Antwerpen, Edegem, Belgium
| |
Collapse
|
24
|
Matas AJ, Berglund DM, Vock DM, Ibrahim HN. Causes and timing of end-stage renal disease after living kidney donation. Am J Transplant 2018; 18:1140-1150. [PMID: 29369517 DOI: 10.1111/ajt.14671] [Citation(s) in RCA: 47] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2017] [Revised: 12/14/2017] [Accepted: 01/04/2018] [Indexed: 01/25/2023]
Abstract
End-stage renal disease (ESRD) is a risk after kidney donation. We sought, in a large cohort of kidney donors, to determine the causes of donor ESRD, the interval from donation to ESRD, the role of the donor/recipient relationship, and the trajectory of the estimated GFR (eGFR) from donation to ESRD. From 1/1/1963 thru 12/31/2015, 4030 individuals underwent living donor nephrectomy at our center, as well as ascertainment of ESRD status. Of these, 39 developed ESRD (mean age ± standard deviation [SD] at ESRD, 62.4 ± 14.1 years; mean interval between donation and ESRD, 27.1 ± 9.8 years). Donors developing ESRD were more likely to be male, as well as smokers, and younger at donation, and to have donated to a first-degree relative. Of donors with a known cause of ESRD (n = 25), 48% was due to diabetes and/or hypertension; only 2 from a disease that would have affected 1 kidney (cancer). Of those 25 with an ascertainable ESRD cause, 4 shared a similar etiology of ESRD with their recipient. Almost universally, thechange of eGFR over time was stable, until new-onset disease (kidney or systemic). Knowledge of factors contributing to ESRD after living kidney donation can improve donor selection and counseling, as well as long-term postdonation care.
Collapse
Affiliation(s)
- Arthur J Matas
- Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Danielle M Berglund
- Informatics Services for Research and Reporting, Fairview, Minneapolis, MN, USA
| | - David M Vock
- Division of Biostatistics, University of Minnesota, Minneapolis, MN, USA
| | - Hassan N Ibrahim
- Division of Renal Diseases and Hypertension, Houston Methodist Hospital, Houston, TX, USA
| |
Collapse
|
25
|
Wainright JL, Robinson AM, Wilk AR, Klassen DK, Cherikh WS, Stewart DE. Risk of ESRD in prior living kidney donors. Am J Transplant 2018; 18:1129-1139. [PMID: 29392849 DOI: 10.1111/ajt.14678] [Citation(s) in RCA: 68] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 01/23/2018] [Accepted: 01/24/2018] [Indexed: 01/25/2023]
Abstract
We studied End-Stage Renal Disease (ESRD) in living kidney donors (LKDs) who donated in the United States between 1994 and 2016 (n = 123 526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. Two hundred eighteen LKDs developed ESRD, with a median of 11.1 years between donation and ESRD. Absolute 20-year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKDs had increased risk of ESRD if they were male (adjusted hazard ratio [aHR]: 1.75, 95% confidence interval [95%CI]: 1.33-2.31), had higher BMI (aHR: 1.34 per 5 kg/m2 , 95%CI: 1.10-1.64) or lower estimated GFR (aHR: 0.89 per 10 mL/min, 95% CI: 0.80-0.99), were first-degree relatives of the recipient (parent: [aHR: 2.01, 95% CI: 1.26-3.21]; full sibling [aHR: 1.87, 95%CI: 1.23-2.84]; identical twin [aHR: 19.79, 95%CI: 7.65-51.24]), or lived in lower socioeconomic status neighborhoods at donation (aHR: 0.87 per $10k increase; 95%CI: 0.77-0.99). We found a significant interaction between donation age and race, with higher risk at older ages for white LKDs (aHR: 1.26 per decade, 95%CI: 1.04-1.54), but higher risk at younger ages for black LKDs (aHR: 0.75 per decade, 95%CI: 0.57-0.99). These findings further inform risk assessment of potential LKDs.
Collapse
Affiliation(s)
| | - Amanda M Robinson
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - Amber R Wilk
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - David K Klassen
- Office of the Chief Medical Officer, United Network for Organ Sharing, Richmond, VA, USA
| | - Wida S Cherikh
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| | - Darren E Stewart
- Research Department, United Network for Organ Sharing, Richmond, VA, USA
| |
Collapse
|
26
|
Maggiore U, Budde K, Heemann U, Hilbrands L, Oberbauer R, Oniscu GC, Pascual J, Schwartz Sorensen S, Viklicky O, Abramowicz D. Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group. Nephrol Dial Transplant 2018; 32:216-223. [PMID: 28186535 DOI: 10.1093/ndt/gfw429] [Citation(s) in RCA: 76] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2016] [Accepted: 11/15/2016] [Indexed: 01/10/2023] Open
Abstract
Two recent matched cohort studies from the USA and Norway published in 2014 have raised some concerns related to the long-term safety of kidney living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science and Care for Renal Transplantation in European States (DESCARTES) board members critically review the literature in an effort to summarize the current knowledge concerning long-term risks of kidney living donation to help physicians for decision-making purposes and for providing information to the prospective live donors. Long-term risk of end-stage renal disease (ESRD) can be partially foreseen by trying to identify donors at risk of developing ‘de novo’ kidney diseases during life post-donation and by predicting lifetime ESRD risk. However, lifetime risk may be difficult to assess in young donors, especially in those having first-degree relatives with ESRD. The study from Norway also found an increased risk of death after living donor nephrectomy, which became visible only after >15 years of post-donation follow-up. However, these findings are likely to be largely the result of an overestimation due to the confounding effect related to a family history of renal disease. DESCARTES board members emphasize the importance of optimal risk–benefit assessment and proper information to the prospective donor, which should also include recommendations on health-promoting behaviour post-donation.
Collapse
Affiliation(s)
- Umberto Maggiore
- Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy
| | - Klemens Budde
- Department of Nephrology, Charité Medical University Berlin, Berlin, Germany
| | - Uwe Heemann
- Department of Nephrology, Technical University of Munich, Munich, Germany
| | - Luuk Hilbrands
- Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Rainer Oberbauer
- Department of Nephrology, Medical University of Vienna, Vienna, Austria
| | - Gabriel C Oniscu
- Transplant Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK
| | - Julio Pascual
- Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain
| | | | - Ondrej Viklicky
- Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic
| | - Daniel Abramowicz
- Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium
| | | |
Collapse
|
27
|
Jędrzejko K, Kieszek R, Dor FJMF, Kwapisz M, Nita M, Bieniasz M, Czerwińska M, Kwiatkowski A. Does Low Birthweight Have an Impact on Living Kidney Donor Outcomes? Transplant Proc 2018; 50:1710-1714. [PMID: 30056887 DOI: 10.1016/j.transproceed.2018.04.027] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2017] [Revised: 03/27/2018] [Accepted: 04/09/2018] [Indexed: 10/17/2022]
Abstract
INTRODUCTION Because nearly 30,000 people worldwide become living kidney donors each year, donor safety is of the utmost importance. Recent studies have shown that living kidney donation is associated with an increased relative risk for end-stage renal disease (ESRD). It is essential to determine which donors will be more likely to develop ESRD. One of the risk factors for ESRD in living kidney donors is hypertension and, because there are studies demonstrating that low birthweight is a risk factor for developing hypertension in adult life, we hypothesized that donors with low birthweight may be at higher risk of developing renal disease after donation. METHODS Seventy-three living kidney donors were examined. Donors were divided into 2 cohorts: a group with low birthweight and group with normal birthweight. We checked whether the donor birthweight has an impact on the outcome of donor renal function and on the development of hypertension. RESULTS Hypertension was observed statistically more frequent in the group with low birthweight (P = .003). CONCLUSION Glomerular filtration rate before kidney donation was found to be lower in the low-birthweight group.
Collapse
Affiliation(s)
- K Jędrzejko
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - R Kieszek
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland.
| | - F J M F Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College, London, UK
| | - M Kwapisz
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Nita
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Bieniasz
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - M Czerwińska
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| | - A Kwiatkowski
- Department of General and Transplantational Surgery, Medical University of Warsaw, Warsaw, Poland
| |
Collapse
|
28
|
Naik AS, Cibrik DM, Sakhuja A, Samaniego M, Lu Y, Shahinian V, Norman SP, Schnitzler MA, Kasiske BL, Segev DL, Lentine KL. Temporal trends, center-level variation, and the impact of prevalent state obesity rates on acceptance of obese living kidney donors. Am J Transplant 2018; 18:642-649. [PMID: 28949096 DOI: 10.1111/ajt.14519] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2017] [Revised: 08/30/2017] [Accepted: 09/16/2017] [Indexed: 01/25/2023]
Abstract
The impact of pre-donation obesity on long-term outcomes of living kidney donors remains controversial. Published guidelines offer varying recommendations regarding BMI (kg/m2 ) thresholds for donor acceptance. We examined temporal and center-level variation in BMI of accepted donors across US transplant centers. Using national transplant registry data, we performed multivariate hierarchical logistic regression modeling using pairwise comparisons (overweight, BMI: 25-29.9; mildly obese, BMI: 30-34.9; very obese, BMI: ≥35; versus normal BMI: 18.5-24.9). Metrics of heterogeneity, including median odds ratio (MOR), were calculated. Among 90 013 living kidney donors, 2001-2016, proportions who were very obese decreased and proportions who were mildly obese or overweight increased. Significant center-level heterogeneity was noted in BMI of accepted donors; the MOR varied from 1.10 for overweight to 1.93 for very obese donors. At centers located in the 10 states with the highest general population obesity rates, adjusted odds of very obese donor status were 185% higher (reference: normal BMI) than in states with the lowest obesity rates. Although there is a declining trend in acceptance of very obese living kidney donors, variation across centers is significant. Furthermore, local population obesity rates may affect the decision to accept obese individuals as donors.
Collapse
Affiliation(s)
- Abhijit S Naik
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Diane M Cibrik
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Ankit Sakhuja
- Division of Pulmonary and Critical Care, Mayo Clinic, Rochester, MN, USA
| | - Milagros Samaniego
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Yee Lu
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Vahakn Shahinian
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Silas P Norman
- Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA
| | - Mark A Schnitzler
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
| | - Bertram L Kasiske
- Hennepin County Medical Center, Minneapolis, MN, USA.,Scientific Registry of Transplant Recipients, Minneapolis Medical Research Foundation, Minneapolis, MN, USA
| | - Dorry L Segev
- Abdominal Transplantation, Johns Hopkins University, Baltimore, MD, USA
| | - Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, MO, USA
| |
Collapse
|
29
|
Matas AJ, Vock DM, Ibrahim HN. GFR ≤25 years postdonation in living kidney donors with (vs. without) a first-degree relative with ESRD. Am J Transplant 2018; 18:625-631. [PMID: 28980397 PMCID: PMC5820146 DOI: 10.1111/ajt.14525] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Revised: 08/25/2017] [Accepted: 09/22/2017] [Indexed: 01/25/2023]
Abstract
An increased risk of ESRD has been reported for living kidney donors, and appears to be higher for those donating to a relative. The reasons for this are not clear. One possibility is that ESRD is due to the nephrectomy-related reduction in GFR, followed by an age-related decline that may be more rapid in related donors. Between 1/1/1990 and 12/31/2014, we did 2002 living donor nephrectomies. We compared long-term postdonation eGFR trajectory for donors with (n = 1245) vs. without (n = 757) a first-degree relative with ESRD. Linear mixed-effects models were used to model the longitudinal trajectory of eGFR. With all other variables held constant, we noted a steady average increase in eGFR until donors reached age 70: 1.12 (95% CI: 0.92-1.32) mL/min/1.73m² /yr between 6 weeks and 5 years postdonation; 0.24 (0.00-0.49) mL/min/1.73m² /yr between 5 and 10 years; and 0.07 (-0.10 to +0.25) mL/min/1.73m² /yr between 10 and 20 years for donors with attained age less than 70. After age 70, eGFR declined. After we adjusted for predonation factors, the difference in eGFR slopes between related and unrelated donors was 0.20 mL/min/1.753 m2 /year (0.07-0.33). Our data suggests that postdonation, kidney donor eGFR increases each year for a number of years and that eGFR trajectory does not explain any increase in ESRD after donation.
Collapse
Affiliation(s)
| | - David M. Vock
- Division of Biostatistics, School of Public Health, University of Minnesota
| | | |
Collapse
|
30
|
Abstract
PURPOSE OF REVIEW Kidney transplantation from a living kidney donor (LKD) is associated with better long-term survival and quality of life for a patient with end-stage renal disease (ESRD) than dialysis. We reviewed recent literature on the acceptability and outcomes of older adults as LKDs, which may be misunderstood in routine care. RECENT FINDINGS Studies report that receiving a kidney from an older LKD is associated with worse recipient and graft survival compared with receiving a kidney from a younger LKD, but similar recipient and graft survival to receiving a kidney from a standard criteria deceased donor. A kidney from a younger vs. older LKD results in better graft survival in younger recipients, whereas the graft survival is similar in older recipients. Compared with healthy matched nondonors, older LKDs have a similar risk of death and cardiovascular disease and the absolute risk of ESRD after 15 years remains less than 1%. The estimated predonation and postdonation lifetime risk of ESRD varies by age, sex and race with lower incidences in individuals who are older, female and white (vs. African-American). SUMMARY Donor and recipient outcomes from several studies support the acceptability of older adults as LKDs.
Collapse
Affiliation(s)
- Ngan N Lam
- aDepartment of Medicine, Division of Nephrology, University of Alberta, Edmonton, Alberta bDepartment of Medicine, Division of Nephrology, Western University, London, Ontario, Canada
| | | |
Collapse
|
31
|
Hays R, Rodrigue JR, Cohen D, Danovitch G, Matas A, Schold J, LaPointe Rudow D. Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies. Am J Transplant 2016; 16:1973-81. [PMID: 27037542 DOI: 10.1111/ajt.13813] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/13/2016] [Accepted: 03/19/2016] [Indexed: 01/25/2023]
Abstract
In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation.
Collapse
Affiliation(s)
- R Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - J R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - D Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - G Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - A Matas
- Department of Surgery, University of Minnesota Medical Center-Fairview, Minneapolis, MN
| | - J Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
| |
Collapse
|
32
|
Freedman BI, Pastan SO, Israni AK, Schladt D, Julian BA, Gautreaux MD, Hauptfeld V, Bray RA, Gebel HM, Kirk AD, Gaston RS, Rogers J, Farney AC, Orlando G, Stratta RJ, Mohan S, Ma L, Langefeld CD, Bowden DW, Hicks PJ, Palmer ND, Palanisamy A, Reeves-Daniel AM, Brown WM, Divers J. APOL1 Genotype and Kidney Transplantation Outcomes From Deceased African American Donors. Transplantation 2016; 100:194-202. [PMID: 26566060 DOI: 10.1097/tp.0000000000000969] [Citation(s) in RCA: 126] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Two apolipoprotein L1 gene (APOL1) renal-risk variants in donors and African American (AA) recipient race are associated with worse allograft survival in deceased-donor kidney transplantation (DDKT) from AA donors. To detect other factors impacting allograft survival from deceased AA kidney donors, APOL1 renal-risk variants were genotyped in additional AA kidney donors. METHODS The APOL1 genotypes were linked to outcomes in 478 newly analyzed DDKTs in the Scientific Registry of Transplant Recipients. Multivariate analyses accounting for recipient age, sex, race, panel-reactive antibody level, HLA match, cold ischemia time, donor age, and expanded criteria donation were performed. These 478 transplantations and 675 DDKTs from a prior report were jointly analyzed. RESULTS Fully adjusted analyses limited to the new 478 DDKTs replicated shorter renal allograft survival in recipients of APOL1 2-renal-risk-variant kidneys (hazard ratio [HR], 2.00; P = 0.03). Combined analysis of 1153 DDKTs from AA donors revealed donor APOL1 high-risk genotype (HR, 2.05; P = 3 × 10), older donor age (HR, 1.18; P = 0.05), and younger recipient age (HR, 0.70; P = 0.001) adversely impacted allograft survival. Although prolonged allograft survival was seen in many recipients of APOL1 2-renal-risk-variant kidneys, follow-up serum creatinine concentrations were higher than that in recipients of 0/1 APOL1 renal-risk-variant kidneys. A competing risk analysis revealed that APOL1 impacted renal allograft survival, but not recipient survival. Interactions between donor age and APOL1 genotype on renal allograft survival were nonsignificant. CONCLUSIONS Shorter renal allograft survival is reproducibly observed after DDKT from APOL1 2-renal-risk-variant donors. Younger recipient age and older donor age have independent adverse effects on renal allograft survival.
Collapse
Affiliation(s)
- Barry I Freedman
- 1 Section on Nephrology, Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, NC. 2 Center for Genomics and Personalized Medicine Research, Wake Forest School of Medicine, Winston-Salem, NC. 3 Renal Division, Department of Medicine, Emory University School of Medicine, Atlanta, GA. 4 Division of Nephrology, Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis, MN. 5 Minneapolis Medical Research Foundation, Minneapolis, MN. 6 Division of Nephrology, Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL. 7 General Surgery and HLA Immunogenetics Laboratory, Wake Forest School of Medicine, Winston-Salem, NC. 8 Alabama Regional Histocompatibility Laboratory at UAB, University of Alabama at Birmingham School of Medicine, Birmingham, AL. 9 Department of Pathology and Laboratory Medicine; Emory School of Medicine, Atlanta, GA. 10 Department of Surgery, Duke University School of Medicine, Durham, NC. 11 Department of General Surgery, Wake Forest School of Medicine, Winston-Salem, NC. 12 Division of Nephrology, Department of Medicine, Columbia University College of Physicians and Surgeons and Department of Epidemiology, Mailman School of Public Health, New York, NY. 13 Division of Public Health Sciences and Center for Public Health Genomics, Wake Forest School of Medicine, Winston-Salem, NC
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
33
|
Abstract
In March 1966, the Ciba Foundation sponsored the first international, interdisciplinary symposium focused on ethical and legal issues in transplantation. The attendees included not only physicians and surgeons but also judges and legal scholars, a minister, and a science journalist. In this article, we will consider some of the topics in organ transplantation that were discussed by the attendees, what we have learned in the intervening half century, and the relevance of their discussions today. Specifically, we examine the definition of death and its implications for organ procurement, whether it is ethical and legal to "maim" a living individual for the benefit of another, how to ensure that the consent of the living donor is voluntary and informed, the case of identical twins, the question of whether ethically minors can serve as living donors, the health risks of living donation, the ethics and legality of an organ market, and the economic barriers to living donation. We show that many of the concerns discussed at the Ciba symposium remain highly relevant, and their discussions have helped to shape the ethical boundaries of organ transplantation today.
Collapse
|
34
|
Grams ME, Sang Y, Levey AS, Matsushita K, Ballew S, Chang AR, Chow EK, Kasiske BL, Kovesdy CP, Nadkarni GN, Shalev V, Segev DL, Coresh J, Lentine KL, Garg AX. Kidney-Failure Risk Projection for the Living Kidney-Donor Candidate. N Engl J Med 2016; 374:411-21. [PMID: 26544982 PMCID: PMC4758367 DOI: 10.1056/nejmoa1510491] [Citation(s) in RCA: 302] [Impact Index Per Article: 37.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Evaluation of candidates to serve as living kidney donors relies on screening for individual risk factors for end-stage renal disease (ESRD). To support an empirical approach to donor selection, we developed a tool that simultaneously incorporates multiple health characteristics to estimate a person's probable long-term risk of ESRD if that person does not donate a kidney. METHODS We used risk associations from a meta-analysis of seven general population cohorts, calibrated to the population-level incidence of ESRD and mortality in the United States, to project the estimated long-term incidence of ESRD among persons who do not donate a kidney, according to 10 demographic and health characteristics. We then compared 15-year projections with the observed risk among 52,998 living kidney donors in the United States. RESULTS A total of 4,933,314 participants from seven cohorts were followed for a median of 4 to 16 years. For a 40-year-old person with health characteristics that were similar to those of age-matched kidney donors, the 15-year projections of the risk of ESRD in the absence of donation varied according to race and sex; the risk was 0.24% among black men, 0.15% among black women, 0.06% among white men, and 0.04% among white women. Risk projections were higher in the presence of a lower estimated glomerular filtration rate, higher albuminuria, hypertension, current or former smoking, diabetes, and obesity. In the model-based lifetime projections, the risk of ESRD was highest among persons in the youngest age group, particularly among young blacks. The 15-year observed risks after donation among kidney donors in the United States were 3.5 to 5.3 times as high as the projected risks in the absence of donation. CONCLUSIONS Multiple demographic and health characteristics may be used together to estimate the projected long-term risk of ESRD among living kidney-donor candidates and to inform acceptance criteria for kidney donors. (Funded by the National Institute of Diabetes and Digestive and Kidney Diseases and others.).
Collapse
Affiliation(s)
- Morgan E. Grams
- Division of Nephrology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Yingying Sang
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Andrew S. Levey
- Division of Nephrology at Tufts Medical Center, Boston, MA, USA
| | - Kunihiro Matsushita
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Shoshana Ballew
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Alex R. Chang
- Division of Nephrology, Geisinger Medical Center, Danville, PA, USA
| | - Eric K.H. Chow
- Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Bertram L. Kasiske
- Department of Medicine, Hennepin County Medical Center, and University of Minnesota, Minneapolis, MN, USA
| | - Csaba P. Kovesdy
- Memphis Veterans Affairs Medical Center, Memphis, TN, USA
- University of Tennessee Health Science Center, Memphis, TN, USA
| | - Girish N. Nadkarni
- Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Varda Shalev
- Medical Division, Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Dorry L. Segev
- Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore, MD, USA
| | - Josef Coresh
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, USA
| | - Krista L. Lentine
- Centers for Abdominal Transplantation and Outcomes Research, Saint Louis University, St. Louis, MO, USA
| | - Amit X. Garg
- Departments of Medicine and Epidemiology and Biostatistics, Western University, London, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| |
Collapse
|
35
|
Addressing the ESRD Risks of the Young Living Kidney Donor: Putting “Normal for Now” into Practice. CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0083-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
|
36
|
Taler SJ, Textor SC. Living Kidney Donor Criteria Based on Blood Pressure, Body Mass Index, and Glucose: Age-Stratified Decision-Making in the Absence of Hard Data. CURRENT TRANSPLANTATION REPORTS 2016. [DOI: 10.1007/s40472-016-0091-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
|
37
|
Steiner RW. Moving closer to understanding the risks of living kidney donation. Clin Transplant 2015; 30:10-6. [DOI: 10.1111/ctr.12652] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/24/2015] [Indexed: 01/09/2023]
Affiliation(s)
- Robert W. Steiner
- Center for Transplantation; University of California; San Diego CA USA
- Division of Nephrology; Department of Medicine; School of Medicine; University of California; San Diego CA USA
| |
Collapse
|
38
|
Thiessen C, Gordon EJ, Reese PP, Kulkarni S. Development of a Donor-Centered Approach to Risk Assessment: Rebalancing Nonmaleficence and Autonomy. Am J Transplant 2015; 15:2314-23. [PMID: 25868787 DOI: 10.1111/ajt.13272] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2015] [Revised: 02/11/2015] [Accepted: 02/17/2015] [Indexed: 01/25/2023]
Abstract
Living kidney donors are often excluded from the shared decision making and patient-centered models that are advocated in medical practice. Thresholds for acceptable risk vary between transplant centers, and between clinicians and donors. Although donor selection committees commonly focus on medical risks, potential donors also consider nonmedical risks and burdens, which may alter their assessment of an acceptable level of medical risk. Thus, transplant centers may encounter ethical tensions between nonmaleficence and respect for donor autonomy. A donor-centered model of risk assessment and risk reconciliation would integrate the donor's values and preferences in a shared decision about their eligibility to donate. This paper argues for shifting to a donor-centered model of risk assessment, and presents a research agenda to facilitate the greater participation of donors in their own evaluation and approval processes.
Collapse
Affiliation(s)
- C Thiessen
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
| | - E J Gordon
- Comprehensive Transplant Center, Center for Healthcare Studies, Northwestern University Feinberg School of Medicine, Chicago, IL
| | - P P Reese
- Renal-Electrolyte and Hypertension Division, Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, PA
| | - S Kulkarni
- Department of Surgery, Section of Organ Transplantation & Immunology, Yale University School of Medicine, New Haven, CT
| |
Collapse
|
39
|
Freedman BI, Julian BA, Pastan SO, Israni AK, Schladt D, Gautreaux MD, Hauptfeld V, Bray RA, Gebel HM, Kirk AD, Gaston RS, Rogers J, Farney AC, Orlando G, Stratta RJ, Mohan S, Ma L, Langefeld CD, Hicks PJ, Palmer ND, Adams PL, Palanisamy A, Reeves-Daniel AM, Divers J. Apolipoprotein L1 gene variants in deceased organ donors are associated with renal allograft failure. Am J Transplant 2015; 15:1615-22. [PMID: 25809272 PMCID: PMC4784684 DOI: 10.1111/ajt.13223] [Citation(s) in RCA: 137] [Impact Index Per Article: 15.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/10/2014] [Revised: 11/05/2014] [Accepted: 11/22/2014] [Indexed: 01/25/2023]
Abstract
Apolipoprotein L1 gene (APOL1) nephropathy variants in African American deceased kidney donors were associated with shorter renal allograft survival in a prior single-center report. APOL1 G1 and G2 variants were genotyped in newly accrued DNA samples from African American deceased donors of kidneys recovered and/or transplanted in Alabama and North Carolina. APOL1 genotypes and allograft outcomes in subsequent transplants from 55 U.S. centers were linked, adjusting for age, sex and race/ethnicity of recipients, HLA match, cold ischemia time, panel reactive antibody levels, and donor type. For 221 transplantations from kidneys recovered in Alabama, there was a statistical trend toward shorter allograft survival in recipients of two-APOL1-nephropathy-variant kidneys (hazard ratio [HR] 2.71; p = 0.06). For all 675 kidneys transplanted from donors at both centers, APOL1 genotype (HR 2.26; p = 0.001) and African American recipient race/ethnicity (HR 1.60; p = 0.03) were associated with allograft failure. Kidneys from African American deceased donors with two APOL1 nephropathy variants reproducibly associate with higher risk for allograft failure after transplantation. These findings warrant consideration of rapidly genotyping deceased African American kidney donors for APOL1 risk variants at organ recovery and incorporation of results into allocation and informed-consent processes.
Collapse
Affiliation(s)
- Barry I. Freedman
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC,Center for Human Genomics & Personalized Medicine Research, Wake Forest School of Medicine; Winston-Salem, NC
| | - Bruce A. Julian
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham School of Medicine; Birmingham, AL
| | - Stephen O. Pastan
- Department of Medicine, Renal Division, Emory University School of Medicine; Atlanta, GA
| | - Ajay K. Israni
- Department of Medicine, Division of Nephrology, Hennepin County Medical Center, University of Minnesota; Minneapolis, MN,Minneapolis Medical Research Foundation; Minneapolis, MN
| | - David Schladt
- Minneapolis Medical Research Foundation; Minneapolis, MN
| | - Michael D. Gautreaux
- General Surgery & HLA Immunogenetics Lab, Wake Forest School of Medicine; Winston-Salem, NC
| | - Vera Hauptfeld
- Alabama Regional Histocompatibility Laboratory at UAB, University of Alabama at Birmingham School of Medicine; Birmingham, AL
| | - Robert A. Bray
- Department of Pathology & Lab Medicine; Emory School of Medicine; Atlanta, GA
| | - Howard M. Gebel
- Department of Pathology & Lab Medicine; Emory School of Medicine; Atlanta, GA
| | - Allan D. Kirk
- Department of General Surgery, Duke University School of Medicine; Durham, NC
| | - Robert S. Gaston
- Department of Medicine, Division of Nephrology, University of Alabama at Birmingham School of Medicine; Birmingham, AL
| | - Jeffrey Rogers
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Alan C. Farney
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Giuseppe Orlando
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Robert J. Stratta
- Department of General Surgery, Wake Forest School of Medicine; Winston-Salem, NC
| | - Sumit Mohan
- Division of Nephrology, Department of Medicine, Columbia University College of Physicians & Surgeons, New York, NY
| | - Lijun Ma
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Carl D. Langefeld
- Division of Public Health Sciences, Wake Forest School of Medicine; Winston-Salem, NC
| | - Pamela J. Hicks
- Center for Human Genomics & Personalized Medicine Research, Wake Forest School of Medicine; Winston-Salem, NC
| | - Nicholette D. Palmer
- Center for Human Genomics & Personalized Medicine Research, Wake Forest School of Medicine; Winston-Salem, NC
| | - Patricia L. Adams
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Amudha Palanisamy
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Amber M. Reeves-Daniel
- Department of Internal Medicine, Section on Nephrology, Wake Forest School of Medicine; Winston-Salem, NC
| | - Jasmin Divers
- Division of Public Health Sciences, Wake Forest School of Medicine; Winston-Salem, NC
| |
Collapse
|
40
|
|
41
|
Tan JC, Gordon EJ, Dew MA, LaPointe Rudow D, Steiner RW, Woodle ES, Hays R, Rodrigue JR, Segev DL. Living Donor Kidney Transplantation: Facilitating Education about Live Kidney Donation--Recommendations from a Consensus Conference. Clin J Am Soc Nephrol 2015; 10:1670-7. [PMID: 25908792 DOI: 10.2215/cjn.01030115] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The Best Practice in Live Kidney Donation Consensus Conference held in June of 2014 included the Best Practices in Living Donor Education Workgroup, whose charge was to identify best practice strategies in education of living donors, community outreach initiatives, commercial media, solicitation, and state registries. The workgroup's goal was to identify critical content to include in living kidney donor education and best methods to deliver educational content. A detailed summary of considerations regarding educational content issues for potential living kidney donors is presented, including the consensus that was reached. Educational topics that may require updating on the basis of emerging studies on living kidney donor health outcomes are also presented. Enhancing the educational process is important for increasing living donor comprehension to optimize informed decision-making.
Collapse
Affiliation(s)
- Jane C Tan
- Department of Medicine, Stanford University School of Medicine, Palo Alto, California;
| | - Elisa J Gordon
- Center for Healthcare Studies and Comprehensive Transplant Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mary Amanda Dew
- Departments of Psychiatry, Psychology, Epidemiology, and Biostatistics, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Medical Center, New York, New York
| | - Robert W Steiner
- Department of Medicine, University of California at San Diego, San Diego, California
| | - E Steve Woodle
- Division of Transplantation, Department of Surgery, University of Cincinnati, Cincinnati, Ohio
| | - Rebecca Hays
- Transplant Center, University of Wisconsin Hospital, Madison, Wisconsin
| | - James R Rodrigue
- Transplant Institute, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts; and
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | |
Collapse
|
42
|
Mjøen G, Holdaas H. Impact of Living Kidney Donation on Long-Term Renal and Patient Survival: An Evolving Paradigm. CURRENT TRANSPLANTATION REPORTS 2014. [DOI: 10.1007/s40472-014-0038-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
|
43
|
Saito T, Uchida K, Ishida H, Tanabe K, Nitta K. Changes in glomerular filtration rate after donation in living kidney donors: A single-center cohort study. Int Urol Nephrol 2014; 47:397-403. [DOI: 10.1007/s11255-014-0861-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 10/19/2014] [Indexed: 10/24/2022]
|
44
|
Reese PP, Bloom RD, Feldman HI, Rosenbaum P, Wang W, Saynisch P, Tarsi NM, Mukherjee N, Garg AX, Mussell A, Shults J, Even-Shoshan O, Townsend RR, Silber JH. Mortality and cardiovascular disease among older live kidney donors. Am J Transplant 2014; 14:1853-61. [PMID: 25039276 PMCID: PMC4105987 DOI: 10.1111/ajt.12822] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Revised: 05/06/2014] [Accepted: 05/07/2014] [Indexed: 01/25/2023]
Abstract
Over the past two decades, live kidney donation by older individuals (≥55 years) has become more common. Given the strong associations of older age with cardiovascular disease (CVD), nephrectomy could make older donors vulnerable to death and cardiovascular events. We performed a cohort study among older live kidney donors who were matched to healthy older individuals in the Health and Retirement Study. The primary outcome was mortality ascertained through national death registries. Secondary outcomes ascertained among pairs with Medicare coverage included death or CVD ascertained through Medicare claims data. During the period from 1996 to 2006, there were 5717 older donors in the United States. We matched 3368 donors 1:1 to older healthy nondonors. Among donors and matched pairs, the mean age was 59 years; 41% were male and 7% were black race. In median follow-up of 7.8 years, mortality was not different between donors and matched pairs (p = 0.21). Among donors with Medicare, the combined outcome of death/CVD (p = 0.70) was also not different between donors and nondonors. In summary, carefully selected older kidney donors do not face a higher risk of death or CVD. These findings should be provided to older individuals considering live kidney donation.
Collapse
Affiliation(s)
- P P Reese
- Renal Electrolyte & Hypertension Division, Department of Medicine, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics and Epidemiology, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | | | | | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
45
|
Panocchia N, Bossola M, Silvestri P, Midolo E, Teleman AA, Tazza L, Sacchini D, Minacori R, Di Pietro ML, Spagnolo AG. Ethical evaluation of risks related to living donor transplantation programs. Transplant Proc 2014; 45:2601-3. [PMID: 24034000 DOI: 10.1016/j.transproceed.2013.07.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
The shortage of available cadaveric organs for transplantation and the growing demand has incresed live donation. To increase the number of transplantations from living donors, programs have been implemented to coordinate donations in direct or indirect form (cross-over, paired, and domino chain). Living donors with complex medical conditions are accepted by several transplantation programs. In this way, the number of transplants from living has exceeded that from cadaver donors in several European countries. No mortality has been reported in the case of lung, pancreas, or intestinal Living donations, but the perioperative complications range from 15% to 30% for pancreas and lung donors. In living kidney donors, the perioperative mortality is 3 per 10,000. Their frequency of end-stage renal disease does not exceed the United States rate for the general population. However, long-term follow-up studies of living donors for kidney transplantations have several limitations. The frequency of complications in live donor liver transplantation is 40%, of these, 48% are possibly life-threatening according to the Clavien classification. Residual disability, liver failure, or death has occurred in 1% of cases. The changes in live donor acceptance criteria raise ethical issues, in particular, the physician's role in evaluating and accepting the risks taken by the living donor. Some workers argue to set aside medical paternalism on behalf of the principle of donor autonomy. In this way the medical rule "primum non nocere" is overcome. Transplantation centers should reason beyond the shortage of organs and think in terms of the care for both donor and recipient.
Collapse
Affiliation(s)
- N Panocchia
- Hemodialysis Service, Department of Surgery, Faculty of Medicine, Università Cattolica del Sacro Cuore, Rome, Italy.
| | | | | | | | | | | | | | | | | | | |
Collapse
|
46
|
MacDonald D, Kukla AK, Ake S, Berglund D, Jackson S, Issa N, Spong R, Matas AJ, Ibrahim HN. Medical outcomes of adolescent live kidney donors. Pediatr Transplant 2014; 18:336-41. [PMID: 24646177 DOI: 10.1111/petr.12238] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/24/2014] [Indexed: 11/30/2022]
Abstract
Living kidney donation from donors <18 yr of age is uncommon. The majority of donations from adolescents took place several decades ago providing a unique opportunity to study true long-term consequences of donation. We compared survival, renal outcomes, and rates of hypertension and diabetes among 42 adolescent donors and matched older controls. Adolescent donors were matched with donors 18-30 yr on the following: gender, relation to the recipient, BMI at donation, eGFR at donation, and year of donation. After a mean follow-up of 31.8 ± 8.0 yr, 94.9% of adolescent donors were alive vs. 93.8% of controls. There was no significant difference in having eGFR (MDRD) <60 mL/min/1.73 m(2) (26.1% vs. 40.9%), hypertension (35.9% vs. 39.4%), diabetes (5.1% vs. 12.5%), or proteinuria (15.4% vs. 14.1%): adolescent donors vs. controls for all comparisons. These data suggest that adolescent donors are not at a higher risk of shortened survival, hypertension, diabetes, or proteinuria. Nevertheless, they probably should donate only when other options are exhausted as they have to live with a single kidney for decades and longer follow-up is needed.
Collapse
Affiliation(s)
- David MacDonald
- Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis, MN, USA
| | | | | | | | | | | | | | | | | |
Collapse
|
47
|
Niemi M, Mandelbrot DA. The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient. CURRENT TRANSPLANTATION REPORTS 2014; 1:1-9. [PMID: 24579060 PMCID: PMC3933185 DOI: 10.1007/s40472-013-0001-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Living kidney donation is an important option for patients with end-stage renal disease (ESRD), and has improved life expectancy and quality for patients otherwise requiring maintenance dialysis or deceased-donor transplantation. Given the favorable outcomes of live donation and the shortage of organs to transplant, individuals with potentially unfavorable demographic and clinical characteristics are increasingly being permitted to donate kidneys. While this trend has successfully expanded the live donor pool, it has raised concerns as to which acceptance criteria are safe. This review aims to summarize the existing literature on the outcomes of transplantation from medically complex, living kidney donors, including both donor and recipient outcomes when available.
Collapse
Affiliation(s)
- Matthew Niemi
- Division of Nephrology, Department of Medicine Beth Israel Deaconess Medical Center 185 Pilgrim Road, Farr 8 Boston, MA 02215
| | - Didier A Mandelbrot
- The Transplant Center Beth Israel Deaconess Medical Center 110 Francis Street, LMOB 7 Boston, MA 02215
| |
Collapse
|
48
|
Steiner RW, Ix JH, Rifkin DE, Gert B. Estimating risks of de novo kidney diseases after living kidney donation. Am J Transplant 2014; 14:538-44. [PMID: 24612746 DOI: 10.1111/ajt.12625] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2013] [Revised: 11/28/2013] [Accepted: 12/04/2013] [Indexed: 01/25/2023]
Abstract
De novo post donation renal diseases, such as glomerulonephritis or diabetic nephropathy, are infrequent and distinct from the loss of GFR at donation that all living kidney donors experience. Medical findings that increase risks of disease (e.g. microscopic hematuria,borderline hemoglobin A1C) often prompt donor refusal by centers. These risk factors are part of more comprehensive risks of low GFR and end-stage renal disease (ESRD) from kidney diseases in the general population that are equally relevant. Such data profile the ages of onset, rates of progression, prevalence and severity of loss of GFR from generically characterized kidney diseases. Kidney diseases typically begin in middle age and take decades to reach ESRD, at a median age of 64. Diabetes produces about half of yearly ESRD and even more lifetime near-ESRD. Such data predict that (1) 10- to 15-year studies will not capture the lifetime risks of post donation ESRD; (2)normal young donors are at demonstrably higher risk than normal older candidates; (3) low-normal predonation GFRs become risk factors for ESRD when kidney diseases arise and (4) donor nephrectomy always increases individual risk. Such population-based risk data apply to all donor candidates and should be used to make acceptance standards and counseling more uniform and defensible.
Collapse
|
49
|
Bergen CR, Reese PP, Collins D. Nutrition assessment and counseling of the medically complex live kidney donor. Nutr Clin Pract 2014; 29:207-14. [PMID: 24523133 DOI: 10.1177/0884533613520566] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Kidney transplantation is the preferred option for patients with end-stage renal disease facing the need for dialysis because it provides maximum survival benefit. The number of people seeking kidney transplantation greatly exceeds available deceased donor organs. Organs from live donors provide a survival advantage over organs from deceased donors while also broadening the pool of available organs. The purpose of this review is to discuss the clinical guidelines that pertain to live kidney organ donation and to describe the nutrition evaluation and care of live kidney donors. The process for living kidney donation is dictated by policies centered on protecting the donor. In a perfect world, the living donor would present with a flawless medical examination and a benign family health history. The obesity epidemic has emerged as a major health concern. Live donor programs are faced with evaluating increasing numbers of obese candidates. These "medically complex donors" may present with obesity and its associated comorbid conditions, including hypertension, impaired glycemic control, and kidney stone disease. The dietitian's role in the live donor program is not well defined. Participation in the living donor selection meeting, where details of the evaluation are summarized, provides a platform for risk stratification and identification of donors who are at increased lifetime risk for poor personal health outcomes. Guiding the donor toward maintenance of a healthy weight through diet and lifestyle choices is a legitimate goal to minimize future health risks.
Collapse
Affiliation(s)
- Carol R Bergen
- Carol R. Bergen, CSR, LDN, Hospital of the University of Pennsylvania, Clinical Nutrition Support Service, 1910 Penn Tower, Philadelphia, PA 19104, USA.
| | | | | |
Collapse
|
50
|
Abstract
For most patients with end-stage renal disease (ESRD), a kidney transplant is the best treatment option. Compared with dialysis, a successful kidney transplant is associated with increased life expectancy and improved quality of life; a living donor transplant is associated with better long-term results than a deceased donor transplant.
Collapse
|