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Bielopolski D, Yemini R, Gravetz A, Yoskovitch O, Keidar A, Carmeli I, Mor E, Rahamimov R, Rozen-Zvi B, Nesher E. Bariatric Surgery in Severely Obese Kidney Donors Before Kidney Transplantation: A Retrospective Study. Transplantation 2023; 107:2018-2027. [PMID: 37291708 DOI: 10.1097/tp.0000000000004645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Bariatric surgery (BS) is the optimal approach for sustained weight loss and may alter donation candidacy in potential donors with obesity. We evaluated the long-term effects of nephrectomy after BS on metabolic profile, including body mass index, serum lipids and diabetes, and kidney function of donors. METHODS This was a single-center retrospective study. Live kidney donors who underwent BS before nephrectomy were matched for age, gender, and body mass index with patients who underwent BS alone and with donors who underwent nephrectomy alone. Estimated glomerular filtration rate (eGFR) was calculated according to Chronic Kidney Disease Epidemiology Collaboration and adjusted to individual body surface area to create absolute eGFR. RESULTS Twenty-three patients who underwent BS before kidney donation were matched to 46 controls who underwent BS alone. At the last follow-up, the study group showed significantly worse lipid profile with low-density lipoprotein of 115 ± 25 mg/dL versus the control group with low-density lipoprotein of 99 ± 29 mg/dL ( P = 0.036) and mean total cholesterol of 191 ± 32 versus 174 ± 33 mg/dL ( P = 0.046). The second control group of matched nonobese kidney donors (n = 72) had similar serum creatinine, eGFR, and absolute eGFR as the study group before nephrectomy and 1 y after the procedure. At the end of follow-up, the study group had significantly higher absolute eGFR compared with the control group (86 ± 21 versus 76 ± 18 mL/min; P = 0.02) and similar serum creatinine and eGFR. CONCLUSIONS BS before live kidney donation is a safe procedure that could increase the donor pool and improve their health in the long run. Donors should be encouraged to maintain their weight and avoid adverse lipid profile and hyperfiltration.
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Affiliation(s)
- Dana Bielopolski
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Renana Yemini
- Department of Surgery, Assuta Medical Center Ashdod, Israel
- Faculty of Health Sciences, Ben Gurion University of the Negev, Beer-Sheva, Israel
| | - Aviad Gravetz
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Oz Yoskovitch
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
| | - Andrei Keidar
- Department of Surgery, Assuta Medical Center Ashdod, Israel
| | - Idan Carmeli
- Department of Surgery, Assuta Medical Center Ashdod, Israel
| | - Eytan Mor
- Department of Surgery B, Transplant Center, Sheba Medical Center, Ramat-Gan, Israel
| | - Ruth Rahamimov
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Benaya Rozen-Zvi
- Department of Nephrology and Hypertension, Rabin Medical Center, Petah-Tikva, Israel
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
| | - Eviatar Nesher
- Department of Medicine, Medical School, Tel-Aviv University, Tel-Aviv, Israel
- Department of Transplant Surgery, Rabin Medical Center, Petach-Tikva, Israel
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Reed RD, McLeod MC, MacLennan PA, Kumar V, Pittman SE, Maynor AG, Stanford LA, Baker GA, Schinstock CA, Silkensen JR, Roll GR, Segev DL, Orandi BJ, Lewis CE, Locke JE. Change in Body Mass Index and Attributable Risk of New-Onset Hypertension Among Obese Living Kidney Donors. Ann Surg 2023; 278:e115-e122. [PMID: 35946818 PMCID: PMC9911559 DOI: 10.1097/sla.0000000000005669] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To examine whether body mass index (BMI) changes modify the association between kidney donation and incident hypertension. BACKGROUND Obesity increases hypertension risk in both general and living kidney donor (LKD) populations. Donation-attributable risk in the context of obesity, and whether weight change modifies that risk, is unknown. METHODS Nested case-control study among 1558 adult LKDs (1976-2020) with obesity (median follow-up: 3.6 years; interquartile range: 2.0-9.4) and 3783 adults with obesity in the Coronary Artery Risk Development in Young Adults (CARDIA) and Atherosclerosis Risk in Communities (ARIC) studies (9.2 y; interquartile range: 5.3-15.8). Hypertension incidence was compared by donor status using conditional logistic regression, with BMI change investigated for effect modification. RESULTS Overall, LKDs and nondonors had similar hypertension incidence [incidence rate ratio (IRR): 1.16, 95% confidence interval (95% CI): 0.94-1.43, P =0.16], even after adjusting for BMI change (IRR: 1.25, 95% CI: 0.99-1.58, P =0.05). Although LKDs and nondonors who lost >5% BMI had comparable hypertension incidence (IRR: 0.78, 95% CI: 0.46-1.34, P =0.36), there was a significant interaction between donor and >5% BMI gain (multiplicative interaction IRR: 1.62, 95% CI: 1.15-2.29, P =0.006; relative excess risk due to interaction: 0.90, 95% CI: 0.24-1.56, P =0.007), such that LKDs who gained weight had higher hypertension incidence than similar nondonors (IRR: 1.83, 95% CI: 1.32-2.53, P <0.001). CONCLUSIONS Overall, LKDs and nondonors with obesity had similar hypertension incidence. Weight stability and loss were associated with similar hypertension incidence by donor status. However, LKDs who gained >5% saw increased hypertension incidence versus similar nondonors, providing support for counseling potential LKDs with obesity on weight management postdonation.
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Affiliation(s)
- Rhiannon D. Reed
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | | | - Paul A. MacLennan
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Vineeta Kumar
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Sydney E. Pittman
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Andrew G. Maynor
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Luke A. Stanford
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Gavin A. Baker
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | | | | | - Garrett R. Roll
- Division of Transplant, Department of Surgery, University of California San Francisco
| | | | - Babak J. Orandi
- Comprehensive Transplant Institute, University of Alabama at Birmingham
| | - Cora E. Lewis
- Department of Epidemiology, School of Public Health, University of Alabama at Birmingham
| | - Jayme E. Locke
- Comprehensive Transplant Institute, University of Alabama at Birmingham
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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.
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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.
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4
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Kanbay M, Copur S, Ucku D, Zoccali C. Donor obesity and weight gain after transplantation: two still overlooked threats to long-term graft survival. Clin Kidney J 2022; 16:254-261. [PMID: 36755848 PMCID: PMC9900567 DOI: 10.1093/ckj/sfac216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Indexed: 11/12/2022] Open
Abstract
The effect of donor obesity on kidney transplantation success has long been an overlooked clinical research area. Even though there is no strict guideline in most countries prohibiting donation from obese individuals, most candidates with a body mass index >35-40 kg/m2 are rejected due to concerns regarding long-term renal functional deterioration in the donor. The effects of excessive fat mass on renal function and allograft survival have been analysed by several longitudinal and follow-up studies. These studies have documented the deleterious effect on long-term graft outcomes of excessive body mass in living kidney donors and de novo obesity or pre-existing obesity worsening after transplantation on kidney outcomes. However, there is a paucity of clinical trials aimed at countering overweight and obesity in living and deceased kidney donors and in transplant patients. In this review we will briefly discuss the mechanism whereby fat excess induces adverse kidney outcomes and describe the effects on graft function and survival in living obese donors.
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Affiliation(s)
| | - Sidar Copur
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Duygu Ucku
- Department of Medicine, Koc University School of Medicine, Istanbul, Turkey
| | - Carmine Zoccali
- Renal Research Institute, New York, NY, USA,Department of Medicine, Division of Nephrology, Associazione Ipertensione, Nefrologia e Trapianto Renale, Nefrologia, Ospedali Riuniti, Reggio Calabria, Italy
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5
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Bellini MI, Nozdrin M, Pengel L, Knight S, Papalois V. Risks for donors associated with living kidney donation: meta-analysis. Br J Surg 2022; 109:671-678. [PMID: 35612960 PMCID: PMC10364766 DOI: 10.1093/bjs/znac114] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2021] [Revised: 12/30/2021] [Accepted: 03/21/2022] [Indexed: 08/02/2023]
Abstract
BACKGROUND Living kidney donation risk is likely to differ according to donor's demographics. We aimed to analyse the effects of age, sex, body mass index (BMI) and ethnicity. METHODS A systematic review and meta-analysis was undertaken of the effects of preoperative patient characteristics on donor kidney function outcomes, surgical complications, and hypertension. RESULTS 5129 studies were identified, of which 31 met the inclusion criteria, mainly from the USA and Europe. The estimated glomerular filtration rate (eGFR) in donors aged over 60 years was a mean of 9.54 ml per min per 1.73 m2 lower than that of younger donors (P < 0.001). Female donors had higher relative short- and long-term survival. BMI of over 30 kg/m2 was found to significantly lower the donor's eGFR 1 year after donation: the eGFR of obese donors was lower than that of non-obese patients by a mean of -2.70 (95 per cent c.i. -3.24 to -2.15) ml per min per 1.73 m2 (P < 0.001). Obesity was also associated with higher blood pressure both before and 1 year after donation, and a higher level of proteinuria, but had no impact on operative complications. In the long term, African donors were more likely to develop end-stage renal disease than Caucasians. CONCLUSION Obesity and male sex were associated with inferior outcomes. Older donors (aged over 60 years) have a larger eGFR decline than younger donors, and African donors have a higher incidence of ESRD than Caucasians.
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Affiliation(s)
- Maria Irene Bellini
- Correspondence to: Maria Irene Bellini, Department of Surgical Sciences, Terza Clinica Chirurgica, Sapienza University, Viale Regina Elena 324, 00161 Roma, Italy (e-mail: )
| | | | - Liset Pengel
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
| | - Simon Knight
- Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
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6
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Recomendaciones para el trasplante renal de donante vivo. Nefrologia 2022. [DOI: 10.1016/j.nefro.2021.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
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7
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Levea SLL, Albin JL. Living Kidney Donation, Obesity, and Dietary Change: Investing in those who give the "gift of life". J Ren Nutr 2022; 32:268-274. [PMID: 35341990 DOI: 10.1053/j.jrn.2022.03.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 03/21/2022] [Indexed: 11/11/2022] Open
Affiliation(s)
- Swee-Ling L Levea
- Division of Nephrology, Department of Internal Medicine, UT Southwestern Medical Center.
| | - Jaclyn L Albin
- Departments of Pediatrics and Internal Medicine, UT Southwestern Medical Center
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8
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Arabi Z, Bukhari M, Hamad A, Altheaby A, Kaysi S. Practice Patterns in the Acceptance of Medically Complex Living Kidney Donors with Obesity, Hypertension, Family History of Kidney Disease, or Donor-Recipient Age Discrepancy. Avicenna J Med 2021; 11:172-184. [PMID: 34881200 PMCID: PMC8648409 DOI: 10.1055/s-0041-1736541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background
To assess the practice patterns of the acceptance of medically complex living kidney donors (MCLKDs).
Methods
We distributed a survey to nephrologists and transplant surgeons (TS) across the world through major international transplant societies. The survey contained questions regarding obesity, abnormal blood glucose profile, mild hypertension, donor-recipient age discrepancy, or family history of kidney disease of unknown etiology.
Results
In total, 239 respondents from 29 countries (42% were nephrologists and 58% were TS).
Most respondents would allow donations from obese donors, especially if they intended to lose weight but would be cautious if these donors had abnormal blood glucose or family history of diabetes mellitus. In hypertensive donors, future pregnancy plans mattered in decisions regarding the acceptance of female donors. Most respondents would allow young donors but would be more cautious if they had a future risk of hypertension or a family history of kidney disease of unknown etiology. They would also allow donations from an older person if prolonged waiting time was anticipated. We found multiple areas of consensus of practice among the diverse members of international transplant societies, with some interesting variations among nephrologists and TS. Conclusions
This survey highlights the practice patterns of the acceptance of MCLKDs among the international community. In the absence of clear guidelines, this survey provides additional information to counsel kidney donors with these conditions.
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Affiliation(s)
- Ziad Arabi
- Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Muhammad Bukhari
- Department of Medicine, Division of Adult Nephrology, Taif University, Taif, Saudi Arabia
| | - Abdullah Hamad
- Department of Medicine, Division of Nephrology, Regional Medical Center of Orangeburg and Calhoun Counties, Orangeburg, South Carolina, United States
| | - Abdulrahman Altheaby
- Department of the Organ Transplant Center, Division of Adult Transplant Nephrology, King Abdulaziz Medical City, King Abdullah International Medical Research Center, King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Saleh Kaysi
- Department of Medicine, Division of Nephrology, CHU, Clermont-Ferrand, France
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9
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Mohamed MM, Daoud A, Quadri S, Casey MJ, Salas MAP, Rao V, Fülöp T, Soliman KM. Hypertension and obesity in living kidney donors. World J Transplant 2021; 11:180-186. [PMID: 34164293 PMCID: PMC8218343 DOI: 10.5500/wjt.v11.i6.180] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 02/26/2021] [Accepted: 05/22/2021] [Indexed: 02/06/2023] Open
Abstract
Over the past few decades, the shortage in the kidney donor pool as compared to the increasing number of candidates on the kidney transplant waitlist led to loosening of kidney donors’ acceptance criteria. Hypertension and obesity represent risk factors for chronic kidney disease, both in native kidneys and those in kidney transplant recipients. While great progress has been made in kidney transplantation from living donors to benefit the recipient survival and quality of life, progress has been slow to fully risk-characterize the donors. This review critically reassesses the current state of understanding regarding the risk of end-stage kidney disease in those donors with obesity, hypertension or both. Accurate risk assessment tools need to be developed urgently to fully understand the risk glomerular filtration rate compensation failure in the remaining kidney of the donors.
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Affiliation(s)
- Mahmoud M Mohamed
- Department of Medicine, Division of Nephrology, University of Tennessee, Memphis, TN 38163, United States
| | - Ahmed Daoud
- Department of Medicine, Division of Nephrology, Cairo University, Cairo 11562, Egypt
| | - Syed Quadri
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Michael J Casey
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Mariah Aurora Posadas Salas
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Vinaya Rao
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
| | - Tibor Fülöp
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
- Medicine Service, Ralph H. Johnson VA Medical Center, Charleston, SC 29401, United States
| | - Karim M Soliman
- Department of Medicine, Division of Nephrology, Medical University of South Carolina, Charleston, SC 29425, United States
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10
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Yoshinaga K, Araki M, Wada K, Sekito T, Watari S, Maruyama Y, Mitsui Y, Sadahira T, Kubota R, Nishimura S, Edamura K, Kobayashi Y, Tanabe K, Takeuchi H, Kitagawa M, Kitamura S, Wada J, Watanabe M, Watanabe T, Nasu Y. Feasible kidney donation with living marginal donors, including diabetes mellitus. IMMUNITY INFLAMMATION AND DISEASE 2021; 9:1061-1068. [PMID: 34102025 PMCID: PMC8342240 DOI: 10.1002/iid3.470] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/14/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
Objectives To compare the donor outcomes of living donor kidney transplantation between standard donors (SDs) and marginal donors (MDs) including diabetic patients (MD + DM). Methods MDs were defined according to Japanese guideline criteria: (a) age >70‐years, (b) blood pressure ≤130/80 mmHg on hypertension medicine, (c) body mass index >25 to ≤32 kg/m2, (d) 24‐h creatinine clearance ≥70 to <80 ml/min/1.73 m2, and (e) hemoglobin A1c > 6.2 or ≤6.5 with oral diabetic medicine. Fifty‐three of 114 donors were MDs. We compared donor kidney functions until 60 months postoperatively. Results No kidney function parameters were different between SDs and MDs. When comparing SD and MD + DM, MD + DM had a lower postoperative eGFR (48 vs. 41 (1 (month), p = .02), 49 vs. 40 (12, p < .01), 48 vs. 42 (24, p = .04), 47 vs. 38 (36, p = .01)) and the percentage of residual eGFR (SD vs. MD + DM: 63 vs. 57 (1 (month), p < .01), 63 vs. 57 (2, p < .01), 64 vs. 56 (12, p < .01), 63 vs. 57 (24, p < .01), 63 vs. 52 (36, p = .02)). However, when MD with a single risk factor of DM was compared to SD, the difference disappeared. Nine out of 12 (75%) MD + DM had ≥2 risk factors. Conclusions Although long‐term observation of donor kidney function is necessary, careful MD + DM selection had the potential to expand the donor pool.
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Affiliation(s)
- Kasumi Yoshinaga
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Motoo Araki
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Koichiro Wada
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Takanori Sekito
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Shogo Watari
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yuki Maruyama
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yosuke Mitsui
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Takuya Sadahira
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Risa Kubota
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Shingo Nishimura
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Kohei Edamura
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yasuyuki Kobayashi
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Katsuyuki Tanabe
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Hidemi Takeuchi
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Masashi Kitagawa
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Shinji Kitamura
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Jun Wada
- Department of Nephrology, Rheumatology, Endocrinology and Metabolism, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Masami Watanabe
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Toyohiko Watanabe
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
| | - Yasutomo Nasu
- Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical ScienceOkayama UniversityOkayamaJapan
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11
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Karatas M, Tatar E, Simsek C, Yıldırım AM, Uslu A. The relationship between serum uric acid levels and development of obesity in living kidney donors after donor nephrectomy. Eur J Clin Invest 2021; 51:e13507. [PMID: 33529360 DOI: 10.1111/eci.13507] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 01/23/2021] [Accepted: 01/27/2021] [Indexed: 01/30/2023]
Abstract
BACKGROUND Hyperuricaemia plays a role in the pathogenesis of obesity and related metabolic disorders. The aim of this study to investigate the relationship between pre-donation serum uric acid (SUA) level and obesity development after nephrectomy in living kidney donors. METHODS Living donors of kidney transplants between 1998 and 2019 were evaluated. Donors with less than 1 year of follow-up were excluded from the study. The participants were divided into two groups according to last control body mass index (BMI) (obese; ≥ 30 kg/m2 and nonobese; <30 kg/m2 ) and median baseline SUA level (<4.6 mg/dL and ≥4.6 mg/dL). RESULTS In the included 240 donors, the mean follow-up was 50 ± 44 (12-216) months. The mean age was 47 ± 11 (19-82) years, and 46.6% of donors were male. At last control, the percentage of obese donors had increased significantly compared to pre-donation time (22.5% vs 33.8%; P < .001) and last control obese donors had both higher baseline SUA (5.1 ± 1.4 vs 4.5 ± 1.2; P < .01) and BMI (30.7 ± 2.6 vs 24.8 ± 3.0; P < .001). Cox regression analysis showed that there is an independent relationship between the baseline SUA level and development of obesity (odds ratio: 1.30 [CI; 1.12-1.50]; P < .001). In Kaplan-Meier analysis, the development of obesity was significantly higher in kidney donors with high SUA level. CONCLUSION Living kidney donors (LKD) have a tendency to obesity after nephrectomy. Preoperative serum uric acid level gives important information in LKDs that it could foresee the development of obesity after donation.
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Affiliation(s)
- Murat Karatas
- Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Erhan Tatar
- Department of Nephrology, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Cenk Simsek
- Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Ali Murat Yıldırım
- Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Adam Uslu
- Department of General Surgery and Transplantation, University of Health Sciences, Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
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12
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Locke JE, Shelton B, Orandi B, Olthoff K, Pomfret E, Forde KA, Sawinski D, Gray M, Ascher N. Obesity is a risk factor for progression to kidney transplant waitlisting after liver transplantation. Clin Transplant 2021; 35:e14317. [PMID: 33866616 DOI: 10.1111/ctr.14317] [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: 01/17/2021] [Revised: 03/26/2021] [Accepted: 04/06/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Non-alcoholic steatohepatitis has emerged as a leading cause of cirrhosis, and obesity-associated comorbidities, including renal disease, have increased in prevalence. Obesity predisposes the kidney to hyperfiltration injury, potentially impairing acute kidney injury recovery. Identification of patients at risk for renal dysfunction is impeded by poor performance of renal function estimating equations among cirrhotics. To better understand obesity among cirrhotics and renal disease progression, we examined likelihood of kidney transplantation (KT) waitlisting after liver transplant alone (LTA) by obesity class. METHODS 68 607 LTA recipients were identified in SRTR (2005-2018). Fine and Gray competing risks models were used to analyze likelihood of KT waitlisting. RESULTS 27.4% of recipients were obese (BMI ≥ 30 kg/m2 ) and were 10% more likely to require KT waitlisting (aHR: 1.10, 95%CI: 1.01-1.20). Risk was highest among recipients with Classes II and III obesity (BMI: ≥35 kg/m2 ) (aHR: 1.37, 95%CI: 1.17-1.56). Moreover, recipients with Classes II and III obesity were 57% more likely to require KT waitlisting within one year post-LTA (aHR: 1.57, 95%CI: 1.18-2.10) compared to non-obese recipients. DISCUSSION These findings suggest obesity was a risk factor for renal recovery failure and/or renal disease progression post-LTA and may confound identification of renal dysfunction and/or prediction of renal recovery among cirrhotics.
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Affiliation(s)
- Jayme E Locke
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Brittany Shelton
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Babak Orandi
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Kim Olthoff
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | | | - Kimberly A Forde
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Deirdre Sawinski
- University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Meagan Gray
- University of Alabama at Birmingham School of Medicine, Birmingham, AL, USA
| | - Nancy Ascher
- University of California at San Francisco School of Medicine, San Francisco, CA, USA
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13
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Cockerill KJ, Kahn AE, Young SM, Ball CT, Mai ML, Taner CB, Perry DK, Thiel DD. Mayo Adhesive Probability (MAP) score of non-donated kidney aids in predicting post-operative renal function following donor nephrectomy. BMC Urol 2020; 20:124. [PMID: 32807136 PMCID: PMC7433049 DOI: 10.1186/s12894-020-00695-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2019] [Accepted: 08/11/2020] [Indexed: 02/08/2023] Open
Abstract
Background To examine the association of preoperative Mayo Adhesive Probability (MAP) scores in the donor (MAPd) and non-donor kidneys (MAPnd) with post-donation renal function. Methods Three hundred thirty-one patients undergoing hand assisted laparoscopic donor nephrectomy (HALDN) were reviewed. MAPd and MAPnd were obtained. Estimated glomerular filtration rate (eGFR) was recorded preoperatively and at 1 day, 1 month, and 6 months postoperatively. Results Two hundred females and 131 males were evaluated with median BMI 26.4 kg/m2 (range 17.1–39.6) and median age 45 years (range 19–78). MAPd score was 0 for 231 patients (69.8%) and > 0 for 100 patients (30.2%). MAPnd score was 0 for 234 patients (70.7%) and > 0 for 97 patients (29.3%). The median preoperative eGFR was 86.6 ml/min/1.73m2 (range 48.8–138.4). After adjusting for preoperative eGFR, BMI, ASA score, and kidney sidedness, postoperative eGFR was associated with MAP score in the non-donated kidney (p = 0.014) but not in the donated kidney (p = 0.24). Compared to donors with MAPnd = 0, donors with a MAPnd > 0, mean eGFR was − 2.33 ml/min/1.73m2 lower at postoperative day 1 (95% CI − 4.24 to − 0.41, p = 0.018), − 3.02 ml/min/1.73m2 lower at 1 month (95% CI − 5.11 to − 0.93, p = 0.005), and − 2.63 ml/min/1.73m2 lower at 6 months postoperatively (95% CI − 5.01 to − 0.26, p = 0.030). Conclusions MAP score > 0 in the non-donated kidney is associated with worse renal function in the 6 months following HALDN.
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Affiliation(s)
- Katherine J Cockerill
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Amanda E Kahn
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA
| | - Stacy M Young
- Department of Health Sciences Research, Mayo Clinic, Jacksonville, FL, USA
| | - Colleen T Ball
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Jacksonville, FL, USA
| | - Martin L Mai
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - C Burcin Taner
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - Dana K Perry
- Department of Transplantation, Mayo Clinic, Jacksonville, FL, USA
| | - David D Thiel
- Department of Urology, Mayo Clinic, 4500 San Pablo Road, Jacksonville, FL, 32224, USA.
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14
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Melkonian V, Nguyen MTJP. Managing the Obese Living Kidney Donor. CURRENT TRANSPLANTATION REPORTS 2020. [DOI: 10.1007/s40472-020-00279-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
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15
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Brooks JT, Ortiz J. Bariatric surgery for obese donors: A letter to the editor re: Montgomery et al. Am J Transplant 2019; 19:2660. [PMID: 30854777 DOI: 10.1111/ajt.15344] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Affiliation(s)
- Joseph T Brooks
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
| | - Jorge Ortiz
- University of Toledo College of Medicine and Life Sciences, Toledo, Ohio
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16
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Montgomery JR, Telem DA, Waits SA. Bariatric surgery for prospective living kidney donors with obesity? Am J Transplant 2019; 19:2415-2420. [PMID: 30632698 DOI: 10.1111/ajt.15260] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Revised: 12/14/2018] [Accepted: 01/06/2019] [Indexed: 01/25/2023]
Abstract
The obesity epidemic has gripped the transplant community. With nearly 40% of adults in the United States being obese (BMI ≥30 kg/m2 ) and 20% being morbidly obese (BMI ≥35 kg/m2 ), the implications for both donors and recipients of solid organs continue to grow.1 Nowhere is this more impactful than the candidacy of living kidney donors (LKDs). As increasing numbers of obese adults present for LKD consideration and evidence of inferior outcomes among obese LKDs grows, transplant surgeons will become progressively challenged by how to manage these patients in the clinic. Therefore, we offer this Personal Viewpoint to the transplant surgery community in order to review the current impact of obesity on living kidney donation, highlight what weight-loss interventions have already been attempted, and discuss the role that referral for weight-loss interventions including bariatric surgery might have going forward.
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Affiliation(s)
- John R Montgomery
- Department of Transplant Surgery, University of Michigan, Ann Arbor, Michigan
| | - Dana A Telem
- Department of Minimally Invasive Surgery, University of Michigan, Ann Arbor, Michigan
| | - Seth A Waits
- Department of Transplant Surgery, University of Michigan, Ann Arbor, Michigan
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17
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Serrano OK, Sengupta B, Bangdiwala A, Vock DM, Dunn TB, Finger EB, Pruett TL, Matas AJ, Kandaswamy R. Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors. Surgery 2018; 164:1071-1076. [PMID: 30149934 DOI: 10.1016/j.surg.2018.07.015] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Revised: 06/29/2018] [Accepted: 07/08/2018] [Indexed: 12/20/2022]
Abstract
BACKGROUND An elevated body mass index (>30 kg/m2) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors. METHODS Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors-obese donors (body mass index ≥30 kg/m2) versus nonobese donors (body mass index <30 kg/m2). RESULTS Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5%) were obese donors. On univariate analysis, obese donors were more likely to be older (P < .01) and African American (P < .01) and were less likely to be a smoker at the time of donation (P = .01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m2) versus nonobese donors (97 ± 22 mL/min/1.73m2; P < .001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P < .001). Adjusted postoperative length of stay (LOS) was longer (adjusted P = .01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P = .71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P < .001) and hypertension (adjusted hazard ratio (HR) 1.75; P < .001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years). CONCLUSION Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.
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Affiliation(s)
- Oscar K Serrano
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis.
| | - Bodhisatwa Sengupta
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis
| | - Ananta Bangdiwala
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis
| | - David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, Minneapolis
| | - Ty B Dunn
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis
| | - Erik B Finger
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis
| | - Timothy L Pruett
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis
| | - Raja Kandaswamy
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis
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18
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Thukral S, Mazumdar A, Ray DS. Long-Term Consequences of Complex Living Renal Donation: Is It Safe? Transplant Proc 2018; 50:3185-3191. [PMID: 30340774 DOI: 10.1016/j.transproceed.2018.06.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2018] [Accepted: 06/19/2018] [Indexed: 12/31/2022]
Abstract
INTRODUCTION As there is a paucity of literature regarding the long-term outcomes of complex living donors, we conducted this study to assess the effect of kidney donation on the complex living kidney donor. MATERIALS AND METHODS This retrospective study was conducted in Narayan Health Hospital, Kolkata, Eastern India. The cohort consisted of complex living kidney donors who donated kidneys between the years 2007 and 2012. All donors were 60 years old or older, or were younger than 60 years and had comorbidities like hypertension and obesity. After a minimum follow-up of 5 years, all donors underwent evaluation. Data pertaining to hypertension, new-onset diabetes, body mass index (BMI), estimated glomerular filtration rate (eGFR) and albuminuria, and cardiac events were compared from the time of donation till 5 years post-transplant. RESULTS AND DISCUSSION We found a statistically significant increase in blood pressure, number of antihypertensives used, and mean BMI at follow-up. Diabetes mellitus was developed in 22.3% of donors. The mean GFR also decreased significantly at follow-up. There were 42 elderly donors (≥60 years) and 23 ≤ 59 years of age. There was a significant fall of eGFR in both groups, but the percentage fall was similar in both groups. A significant percentage of donors developed proteinuria, the majority being hypertensives. CONCLUSION Procurement of kidneys from marginal donors should be done cautiously, and donors should be assessed for morbidity and mortality in the future, as we found a statistically significant deterioration in renal function, blood pressure, and BMI over long-term follow-up.
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Affiliation(s)
- S Thukral
- Narayana Health Hospital, Mukundapur, Kolkata, India
| | - A Mazumdar
- Narayana Health Hospital, Mukundapur, Kolkata, India
| | - D S Ray
- Narayana Health Hospital, Mukundapur, Kolkata, India.
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19
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Affiliation(s)
- Mala Sachdeva
- Division of Nephrology; Division of Kidney Diseases and Hypertension; Donald and Barbara Zucker School of Medicine at Hofstra/Northwell Department of Medicine; Great Neck New York
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20
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Marcusa DP, Schaubel DE, Woodside KJ, Sung RS. Impact of screening for metabolic syndrome on the evaluation of obese living kidney donors. Am J Surg 2017; 215:144-150. [PMID: 28882358 DOI: 10.1016/j.amjsurg.2017.08.019] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 08/02/2017] [Accepted: 08/28/2017] [Indexed: 11/13/2022]
Abstract
BACKGROUND We report our experience with metabolic syndrome screening for obese living kidney donor candidates to mitigate the long-term risk of CKD. METHODS We retrospectively reviewed 814 obese (BMI≥30) and 993 nonobese living kidney donor evaluations over 12 years. Using logistic regression, we explored interactions between social/clinical variables and candidate acceptance before and after policy implementation. RESULTS Obese donor candidate acceptance decreased after metabolic syndrome screening began (56.3%, 46.3%, p < 0.01), while nonobese candidate acceptance remained similar (59.6%, 59.2%, p = 0.59). Adjusting for age, gender, race, BMI, and number of prior evaluations, acceptance of obese candidates decreased significantly more than nonobese (p = 0.025). In candidates without metabolic syndrome, there was no significant change in how age, sex, race, or BMI affected a donor candidate's probability of acceptance. CONCLUSION Metabolic syndrome screening is a simple stratification tool for centers with liberal absolute BMI cut-offs to exclude potentially higher-risk obese candidates.
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Affiliation(s)
- Daniel P Marcusa
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA
| | | | | | - Randall S Sung
- Department of Surgery, University of Michigan, Ann Arbor, MI, USA.
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21
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Doucet B, Kostner K, Kaiser O, Hawley C, Isbel N. Live donor study - implications of kidney donation on cardiovascular risk with a focus on lipid parameters including lipoprotein a. Nephrology (Carlton) 2017; 21:901-4. [PMID: 27062186 DOI: 10.1111/nep.12792] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2015] [Revised: 03/14/2016] [Accepted: 04/01/2016] [Indexed: 12/29/2022]
Abstract
In this prospective observational cohort study, we evaluate the change in cardiovascular risk parameters, with a focus on lipids, in live kidney donors 1 year post donation. Body mass index, systolic/diastolic blood pressure, kidney function (chromium-51 ethylenediaminetetraacetic acid estimated glomerular filtration) and lipid parameters were measured at baseline and 1 year. Data on 87 live kidney donors were collected. Body mass index increased from 26.5 ± 2.7 pre to 27.4 ± 3.0 kg/m(2) post donation (p < 0.0001). Chromium-51 ethylenediaminetetraacetic acid estimated glomerular filtration decreased from 111.8 ± 20.0 pre to 72.1 ± 13.1 mL/min/1.73 m(2) post donation (p < 0.0001). Serum triglyceride levels increased from 0.8 (interquartile range 0.6-1.3) pre to 1.0 mmol/L (interquartile range 0.7-1.6) post donation (p = 0.0004). Statin use increased from 11.5% pre to 21% post donation (p < 0.005). Low-density lipoprotein remained stable, and other lipids (high-density lipoprotein, apolipoprotein B and lipoprotein a) did not change post donation.
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Affiliation(s)
- Brian Doucet
- Department of Cardiology, Mater Misericordiae Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Karam Kostner
- Department of Cardiology, Mater Misericordiae Hospital, Brisbane, Queensland, Australia.,School of Medicine, University of Queensland, Brisbane, Queensland, Australia
| | - Omar Kaiser
- Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia
| | - Carmel Hawley
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia.,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.,Translational Research Institute, Brisbane, Queensland, Australia.,Australasian Kidney Trials Network, University of Queensland, Brisbane, Queensland, Australia
| | - Nicole Isbel
- School of Medicine, University of Queensland, Brisbane, Queensland, Australia. .,Department of Nephrology, Princess Alexandra Hospital, Brisbane, Queensland, Australia.
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22
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Dru CJ, Fuchs GJ. Long-Term Body Mass Index Trends After Living-Donor Nephrectomy. EXP CLIN TRANSPLANT 2017; 15:521-526. [PMID: 28187700 DOI: 10.6002/ect.2016.0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES As the demand for kidney transplant allografts has increased, many centers are expanding the upper limit of acceptable body mass index for kidney donors. However, obesity is a risk factor for developing renal disease. Our goal was to quantify body mass index trends in donor nephrectomy patients and to institute nutrition counseling to promote sustainable weight loss to reduce the risk of metabolic syndrome-derived renal dysfunction. MATERIALS AND METHODS Ninety patients who underwent donor nephrectomy between 2007 and 2012 consented to having height and weight data collected at multiple time points. After data collection, each patient underwent a standardized nutrition counseling session. One year later, body mass index was reassessed. RESULTS Preoperatively, 52% of the patients were overweight or obese. The percentage of overweight and obese patients remained stable for 2 years after surgery. However, at 3, 4, and 5 years after surgery, these rates increased to 59%, 69%, and 91%. Each patient was counseled about obesity-related comorbidities and provided information about lifestyle modification. One year later, 94% of previously overweight patients and 82% of previously obese patients had a decrease in mean body mass index from 27.2 ± 4.0 kg/m2 to 25.1 ± 3.6 kg/m2. CONCLUSIONS Living-donor nephrectomy patients are at risk of developing obesity, similar to the adult population. Nutrition counseling may be beneficial to help normalize body mass index in patients who have become overweight or obese to potentially prevent obesity-related comorbidities. All patients were evaluated by a nutrition specialist after surgery to review our donor nephrectomy nutrition brochure. Body mass index monitoring and primary care follow-up appear to be appropriate surveillance methods.
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Affiliation(s)
- Christopher J Dru
- From the Urology Academic Practice, Cedars-Sinai Medical Center, Los Angeles, California, USA
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Abstract
Live organ donors typically consult their primary care providers when considering live donation and then return for follow-up after surgery and for ongoing primary care. Live liver and kidney transplants are performed routinely as a method to shorten the waiting time for a recipient, provide a healthy organ for transplant, and increase recipient survival. Careful medical and psychosocial evaluation of the potential donor is imperative to minimize harm. This evaluation must be performed by an experienced live donor medical team. Routine health care with careful attention to weight maintenance, cardiovascular health, and prevention of diabetes and hypertension is paramount.
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Affiliation(s)
- Dianne LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, 1425 Madison Avenue, Box 1105, New York, NY 10029, USA
| | - Karen M Warburton
- Division of Renal, Electrolyte and Hypertension, Penn Transplant Institute, Perelman School of Medicine, University of Pennsylvania, 1 Founders, Renal Division, 3400 Spruce Street, Philadelphia, PA 19104, USA.
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24
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Mağden K, Ucar FB, Velioğlu A, Arıkan H, Yeğen ŞC, Tuğlular S, Özener IÇ. Donor Contraindications to Living Kidney Donation: A Single-Center Experience. Transplant Proc 2016; 47:1299-301. [PMID: 26093703 DOI: 10.1016/j.transproceed.2015.04.050] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
OBJECTIVE Kidney transplantation is the treatment of choice in end-stage renal disease. In Turkey, the inadequate cadaveric donor supply has resulted in transplantation from living kidney donors (LKD) in 80% of transplant operations. LKD candidates undergo a thorough general medical evaluation and are approved to donate their kidneys only if no contraindication is found. In our study we aimed to investigate the reasons and rate of denial for living kidney donation in our center. METHODS We included all LKD candidates who applied to our center between June 2012 to June 2014. Demographic data, rate of rejection, and the reasons for denial to organ donation were analyzed retrospectively. RESULTS Of the 97 LKD candidates included in the study, 60 (62%) were unable to donate their kidneys. Among the reasons for denial were hypertension with target organ damage in 30% (n = 18), immunologic reasons in 23% (n = 14), impaired renal function in 20% (n = 12) cardiovascular reasons 13.3% (n = 8), diabetes mellitus in 10% (n = 6), malignity in 10% (n = 6), obesity (body mass index > 35 kg/m(2)) in 5% (n = 3), and miscellaneous in 18.3% (n = 11). There were >1 reasons in 13 candidates. CONCLUSIONS The problems detected in donor candidates offer a possibility for early detection of disorders and increased awareness.
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Affiliation(s)
- K Mağden
- Division of Nephrology, Department of Internal Medicine, Bülent Ecevit University School of Medicine, Zonguldak, Turkey
| | - F B Ucar
- Marmara University School of Medicine, Turkey
| | - A Velioğlu
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine Hospital, Turkey
| | - H Arıkan
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine Hospital, Turkey
| | - Ş C Yeğen
- Department of General Surgery, Marmara University School of Medicine Hospital, Turkey
| | - S Tuğlular
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine Hospital, Turkey.
| | - I Ç Özener
- Division of Nephrology, Department of Internal Medicine, Marmara University School of Medicine Hospital, Turkey
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25
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Janki S, Klop KWJ, Kimenai HJAN, van de Wetering J, Weimar W, Massey EK, Dehghan A, Rizopoulos D, Völzke H, Hofman A, Ijzermans JNM. LOng-term follow-up after liVE kidney donation (LOVE) study: a longitudinal comparison study protocol. BMC Nephrol 2016; 17:14. [PMID: 26830198 PMCID: PMC4736233 DOI: 10.1186/s12882-016-0227-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/22/2016] [Indexed: 12/20/2022] Open
Abstract
Background The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods The “LOng-term follow-up after liVE kidney donation” (LOVE) study is a single center longitudinal cohort study on long-term consequences after living kidney donation. We will study individuals who have donated a kidney from 1981 through 2010 in the Erasmus University Medical Center in Rotterdam, The Netherlands. In this time period, 1092 individuals donated a kidney and contact information is available for all individuals. Each participating donor will be matched (1:4) to non-donors derived from the population-based cohort studies of the Rotterdam Study and the Study of Health in Pomerania. Matching will be based on baseline age, gender, BMI, ethnicity, kidney function, blood pressure, pre-existing co-morbidity, smoking, the use of alcohol and highest education degree. Follow-up data is collected on kidney function, kidney-related comorbidity, mortality, quality of life and psychological outcomes in all participants. Discussion This study will provide evidence on the long-term consequences of live kidney donation for the donor compared to matched non-donors and evaluate the current donor eligibility criteria. Trial registration Dutch Trial Register NTR3795.
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Affiliation(s)
- Shiromani Janki
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Karel W J Klop
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Hendrikus J A N Kimenai
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Willem Weimar
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Emma K Massey
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Henry Völzke
- Ernst Moritz Arndt University Greifswald, Institute for Community Medicine, Walther-Rathenau-Straße 48, D-17475, Greifswald, Germany.
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jan N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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Sachdeva M, Rosen LM, Varghese J, Fishbane S, Molmenti EP. Weight trends in United States living kidney donors: Analysis of the UNOS database. World J Transplant 2015; 5:137-144. [PMID: 26421266 PMCID: PMC4580928 DOI: 10.5500/wjt.v5.i3.137] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Revised: 06/18/2015] [Accepted: 08/07/2015] [Indexed: 02/05/2023] Open
Abstract
AIM: To analyze the national trends associated with body mass index (BMI) and living kidney donation.
METHODS: Forty-seven thousand seven hundred and five adult living kidney donors as reported to the Organ Procurement and Transplantation Network from 1999 to 2011 were analyzed using their pre-donation BMI. Predictor variables of interest included age, gender, ethnicity, relationship, education status, and transplant region.
RESULTS: Sixteen thousand nine hundred and seventy-one of the living kidney donors were normal weight (35.6%); 19337 were overweight (40.5%); 9007 were mildly obese (18.9%); 1992 were moderate to morbidly obese (4.2%). Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively (P < 0.05). Donors 35-49 years of age, hispanic males or females and black females, those with high school diploma or general Education Degree, and biologically related or partner/spouses were more likely to be obese.
CONCLUSION: Over the past 13 years, the majority of living kidney donors have spanned the overweight to obese categories. Paralleling the national rise is an increase in overweight and mildly obese kidney donors. A fair number of moderate to morbidly obese living kidney donors are still allowed to donate.
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Van Arendonk KJ, Chow EKH, James NT, Orandi BJ, Ellison TA, Smith JM, Colombani PM, Segev ADL. Choosing the order of deceased donor and living donor kidney transplantation in pediatric recipients: a Markov decision process model. Transplantation 2015; 99:360-6. [PMID: 25594552 DOI: 10.1097/tp.0000000000000588] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Most pediatric kidney transplant recipients eventually require retransplantation, and the most advantageous timing strategy regarding deceased and living donor transplantation in candidates with only 1 living donor remains unclear. METHODS A patient-oriented Markov decision process model was designed to compare, for a given patient with 1 living donor, living-donor-first followed if necessary by deceased donor retransplantation versus deceased-donor-first followed if necessary by living donor (if still able to donate) or deceased donor (if not) retransplantation. Based on Scientific Registry of Transplant Recipients data, the model was designed to account for waitlist, graft, and patient survival, sensitization, increased risk of graft failure seen during late adolescence, and differential deceased donor waiting times based on pediatric priority allocation policies. Based on national cohort data, the model was also designed to account for aging or disease development, leading to ineligibility of the living donor over time. RESULTS Given a set of candidate and living donor characteristics, the Markov model provides the expected patient survival over a time horizon of 20 years. For the most highly sensitized patients (panel reactive antibody > 80%), a deceased-donor-first strategy was advantageous, but for all other patients (panel reactive antibody < 80%), a living-donor-first strategy was recommended. CONCLUSIONS This Markov model illustrates how patients, families, and providers can be provided information and predictions regarding the most advantageous use of deceased donor versus living donor transplantation for pediatric recipients.
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Affiliation(s)
- Kyle J Van Arendonk
- 1 Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD. 2 Department of Pediatrics, University of Washington School of Medicine, Seattle, WA. 3 Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD
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Schlieper G, Hess K, Floege J, Marx N. The vulnerable patient with chronic kidney disease. Nephrol Dial Transplant 2015; 31:382-90. [DOI: 10.1093/ndt/gfv041] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2015] [Accepted: 01/25/2015] [Indexed: 11/14/2022] Open
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Obesity Correlates With Glomerulomegaly But Is Not Associated With Kidney Dysfunction Early After Donation. Transplant Direct 2015; 1:1-6. [PMID: 26052546 DOI: 10.1097/txd.0000000000000510] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND Body mass index (BMI) is a convenient measure used to assess obesity and is used to select candidates for kidney donation. Glomerulomegaly is an early indicator of obesity-related kidney disease. Whether obesity assessment by BMI best reflects underlying glomerulomegaly and is predictive of adverse changes in renal function postdonation is unclear. METHODS We performed a retrospective study on a cohort of 1065 living donors at the Mayo Clinic in Rochester; obesity measures by BMI and by computed tomography were compared between 20 donors with largest to 20 donors with the smallest glomerular volumes (on implantation biopsy). In addition, the change in kidney function postdonation (mean 7 months) was compared across BMI groups (<25, 25-29, 30-34, ≥35 kg/m2) in about 500 donors. RESULTS We observed that larger glomerular volume was more strongly associated with BMI per standard deviation (SD) (odds ratio [OR] =5.0, P = 0.002) than waist circumference/height2 per SD (OR = 3.9, P = 0.02), visceral fat/height2 per SD (OR = 2.4, P = 0.02), subcutaneous fat/height2 per SD (OR = 2.0, P = 0.06), renal hilar fat/height2 per SD (OR = 1.6, P = 0.19), or peri/pararenal fat/height2 per SD (OR = 1.5, P = 0.23). Postdonation changes in glomerular filtration rate, blood pressure, and albuminuria were similar across BMI categories. CONCLUSIONS The BMI outperforms various computed tomography measures of abdominal fat in detecting obesity-related glomerulomegaly. Despite this strong association with glomerulomegaly, short-term renal function outcomes are similar across BMI categories. Long-term follow-up is required to definitively define the impact of obesity on kidney function after donation.
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Alberts V, Idu MM, Minnee RC. Risk factors for perioperative complications in hand-assisted laparoscopic donor nephrectomy. Prog Transplant 2014; 24:192-8. [PMID: 24919737 DOI: 10.7182/pit2014240] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Living donor kidney transplant is the preferred treatment for end-stage renal disease; however, the shortage of kidney donors remains a big problem. One of the major reasons for the shortage of living donors is the risk of potentially serious surgical complications of a procedure in which the donor has no personal medical benefit. Therefore it is important to understand the risk factors for perioperative complications associated with donor nephrectomy. Hand-assisted laparoscopic donor nephrectomy is the preferred approach for kidney procurement in many medical centers. This review gives an overview of the risk factors in donor nephrectomy and more specifically in hand-assisted laparoscopic donor nephrectomy.
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Affiliation(s)
| | - Mirza M Idu
- Academic Medical Center, Amsterdam, The Netherlands
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Long term prospective assessment of living kidney donors: single center experience. ISRN NEPHROLOGY 2014; 2014:502414. [PMID: 24967244 PMCID: PMC4045455 DOI: 10.1155/2014/502414] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/16/2013] [Accepted: 10/20/2013] [Indexed: 11/17/2022]
Abstract
Virtually, all studies reporting the outcomes of living kidney donation beyond the first year from donation were retrospective. In this prospective study, the outcome of 81 consecutive living kidney donors was thoroughly evaluated. Clinical, laboratory, and radiological assessments were carried out at predonation (basal), 3, 6, 12, and 24 months after donation. The mean age at time of donation was 37.8 ± 9.8 years and the majority was females (75.3%). The mean BMI increased significantly after donation (P < 0.04). The mean serum creatinine levels (mg/dl) were 0.75 ± 0.14, 1.01 ± 0.22, 0.99 ± 0.21, 0.98 ± 0.20, and 0.94 ± 0.20 (P < 0.0001). Likewise, the mean levels of measured creatinine clearance (mL/min) were 148.8 ± 35.7, 94.7 ± 26.6, 95.5 ± 24.6, 96.7 ± 20.2, and 101.6 ± 26.2 (P < 0.0001). The mean 24 hours urinary protein excretion (gm/dL) were 0.09 ± 0.03, 0.19 ± 0.18, 0.16 ± 0.09, 0.18 ± 0.25, and 0.17 ± 0.12 (P < 0.0001). There were significant increases in the means of the longitudinal and transverse diameters of the remaining kidney over time (P < 0.001). Out of 42 female donors, eleven female donors have got successful postdonation pregnancies. There were no reported surgical complications, either intra- or postoperative. Long-term follow-up is necessary for all living kidney donors through local institutional and world registries. This trial is registered with ClinicalTrials.gov NCT00813579.
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Ahmadi AR, Lafranca JA, Claessens LA, Imamdi RMS, IJzermans JNM, Betjes MGH, Dor FJMF. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Kidney Int 2014; 87:31-45. [PMID: 24786706 DOI: 10.1038/ki.2014.118] [Citation(s) in RCA: 63] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/06/2014] [Accepted: 02/20/2014] [Indexed: 12/11/2022]
Abstract
As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.
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Affiliation(s)
- Ali R Ahmadi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeffrey A Lafranca
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura A Claessens
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Raoul M S Imamdi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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ERBP Guideline on the Management and Evaluation of the Kidney Donor and Recipient. Nephrol Dial Transplant 2014; 28 Suppl 2:ii1-71. [PMID: 24026881 DOI: 10.1093/ndt/gft218] [Citation(s) in RCA: 68] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
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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.
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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
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Moody WE, Tomlinson LA, Ferro CJ, Steeds RP, Mark PB, Zehnder D, Tomson CR, Cockcroft JR, Wilkinson IB, Townend JN. Effect of A Reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: rationale and design of the EARNEST study. Am Heart J 2014; 167:141-149.e2. [PMID: 24439974 PMCID: PMC3904213 DOI: 10.1016/j.ahj.2013.10.024] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2013] [Accepted: 10/28/2013] [Indexed: 01/05/2023]
Abstract
Background There is strong evidence of an association between chronic kidney disease (CKD) and cardiovascular disease. To date, however, proof that a reduction in glomerular filtration rate (GFR) is a causative factor in cardiovascular disease is lacking. Kidney donors comprise a highly screened population without risk factors such as diabetes and inflammation, which invariably confound the association between CKD and cardiovascular disease. There is strong evidence that increased arterial stiffness and left ventricular hypertrophy and fibrosis, rather than atherosclerotic disease, mediate the adverse cardiovascular effects of CKD. The expanding practice of live kidney donation provides a unique opportunity to study the cardiovascular effects of an isolated reduction in GFR in a prospective fashion. At the same time, the proposed study will address ongoing safety concerns that persist because most longitudinal outcome studies have been undertaken at single centers and compared donor cohorts with an inappropriately selected control group. Hypotheses The reduction in GFR accompanying uninephrectomy causes (1) a pressure-independent increase in aortic stiffness (aortic pulse wave velocity) and (2) an increase in peripheral and central blood pressure. Methods This is a prospective, multicenter, longitudinal, parallel group study of 440 living kidney donors and 440 healthy controls. All controls will be eligible for living kidney donation using current UK transplant criteria. Investigations will be performed at baseline and repeated at 12 months in the first instance. These include measurement of arterial stiffness using applanation tonometry to determine pulse wave velocity and pulse wave analysis, office blood pressure, 24-hour ambulatory blood pressure monitoring, and a series of biomarkers for cardiovascular and bone mineral disease. Conclusions These data will prove valuable by characterizing the direction of causality between cardiovascular and renal disease. This should help inform whether targeting reduced GFR alongside more traditional cardiovascular risk factors is warranted. In addition, this study will contribute important safety data on living kidney donors by providing a longitudinal assessment of well-validated surrogate markers of cardiovascular disease, namely, blood pressure and arterial stiffness. If any adverse effects are detected, these may be potentially reversed with the early introduction of targeted therapy. This should ensure that kidney donors do not come to long-term harm and thereby preserve the ongoing expansion of the living donor transplant program (NCT01769924).
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Affiliation(s)
- William E Moody
- Birmingham Cardio-Renal Group, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Laurie A Tomlinson
- Cambridge Clinical Trials Unit, Clinical School, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Charles J Ferro
- Birmingham Cardio-Renal Group, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Richard P Steeds
- Birmingham Cardio-Renal Group, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom
| | - Patrick B Mark
- BHF Cardiovascular Research Centre, Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, United Kingdom
| | - Daniel Zehnder
- Clinical Science Research Laboratory, University of Warwick, Coventry, United Kingdom
| | - Charles R Tomson
- Academic Renal Unit, Learning and Research, Southmead Hospital, Westbury-on-Trym, Bristol, United Kingdom
| | - John R Cockcroft
- Department of Cardiology, Wales Heart Research Institute, University Hospital, Cardiff, United Kingdom
| | - Ian B Wilkinson
- Cambridge Clinical Trials Unit, Clinical School, Addenbrooke's Hospital, University of Cambridge, Cambridge, United Kingdom
| | - Jonathan N Townend
- Birmingham Cardio-Renal Group, Centre for Clinical Cardiovascular Science, Nuffield House, Queen Elizabeth Hospital Birmingham, Birmingham, United Kingdom.
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Abstract
The epidemic of obesity and metabolic syndrome (MS) contributes to the rapid growth of chronic kidney disease (CKD) and end-stage renal disease (ESRD). There is a reverse epidemiology, known as the "obesity paradox," in ESRD patients receiving maintenance dialysis. Obese patients are routinely referred for kidney transplant, and they have more surgical and medical complications than non-obese patients. However, compared to dialysis, kidney transplant provides a survival benefit for obese patients. After kidney transplant, obese patients tend to gain more body weight, and non-obese patients can develop new-onset obesity/MS. Obesity/MS is not only associated with serious morbidities, but also compromises the long-term graft and patient survival. The immunosuppressive drugs commonly used as maintenance therapy, including corticosteroids, calcineurin inhibitors and mammalian target-of-rapamycin inhibitors, contribute to obesity/MS. Development of novel immunosuppressive drugs free of metabolic adverse effects is needed, so that the full potential and benefits of kidney transplantation can be realized.
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Sachdeva M, Sunday S, Israel E, Varghese J, Rosen L, Bhaskaran M, Molmenti EP, Mattana J. Obesity as a barrier to living kidney donation: a center-based analysis. Clin Transplant 2013; 27:882-7. [PMID: 24102846 DOI: 10.1111/ctr.12246] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2013] [Indexed: 12/11/2022]
Abstract
BACKGROUND Obesity is a major epidemic and may present a significant barrier to living kidney donation. The purpose of our study was to determine the frequency of obesity as an exclusion factor and assess how often these donors lose weight and donate. METHODS A single center, retrospective analysis of 104 potential living kidney donors between 2008 and 2012. RESULTS Of the 104 donors, 19 (18%) had a normal body mass index (BMI) of <25. Eighty-five of the 104 (82%) donors spanned the overweight to morbidly obese classifications. Thirty-eight (37%) were overweight (BMI 25-29.9). Twenty-four (23%) were categorized as class I obesity (BMI 30-34.9), 17 (16%) as class II obesity (BMI 35-39.9), and six (6%) as class III obesity (BMI >40). There were a total of 23 donors (22%) who were considered moderately and morbidly obese (BMI >35). Of these, only three (13%) succeeded at losing weight and donating. CONCLUSIONS Obesity may be a frequent barrier to living kidney donation, directly leading to exclusion as a potential kidney donor in about one in five instances. Successful weight loss leading to donation appears to be infrequent, suggesting need to address obesity in the donor population.
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Affiliation(s)
- Mala Sachdeva
- Division of Nephrology, Department of Medicine, Hofstra North Shore-LIJ School of Medicine, North Shore-LIJ Health System, Great Neck, NY, USA
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Patel N, Mason P, Rushton S, Hudson A, Ploeg R, Friend P, Sinha S, Sullivan M. Renal function and cardiovascular outcomes after living donor nephrectomy in the UK: quality and safety revisited. BJU Int 2013; 112:E134-42. [PMID: 23795791 DOI: 10.1111/bju.12213] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
OBJECTIVE To determine renal function and cardiovascular outcomes after living donor nephrectomy (LDN). Living donor kidney transplantation has become established as the treatment of choice for end-stage renal failure. Benefits to the recipient have to be balanced against perioperative and long-term health risks to the donor. SUBJECTS/PATIENTS AND METHODS The UK Transplant Registry (UKTR) was used to identify 4586 living donors who had donated a kidney for transplantation in the UK between 2001 and 2008. This study was conducted with the consent and support of the NHS Blood and Transplant (NHSBT) Kidney and Pancreas Research Group. RESULTS The mean glomerular filtration rate (GFR) fell from 103 mL/min/1.73 m(2) before LDN to 58 mL/min/1.73 m(2) 1 year after LDN. At 1 year after LDN 60% of donors had a GFR of <60 mL/min/1.73 m(2). A GFR of <60 mL/min/1.73 m(2) after LDN was associated with older age, females, lower GFR before LDN, White ethnicity, earlier LDN period, unrelated donor type and body mass index of >25 kg/m(2). Over a 2-year period after LDN there was an overall mortality rate of 0.39%, cardiovascular death in one patient (mortality rate of 0.02%) and a major cardiovascular event rate of 0.44%. CONCLUSION In this study we show that mild renal dysfunction is common after LDN; however, due to the short duration of follow-up we are unable to comment on whether this subsequently leads to an increased risk of developing of cardiovascular disease.
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Affiliation(s)
- Nilay Patel
- Oxford Transplant Centre, The Churchill Hospital, Oxford, UK.
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Gurusinghe S, Brown RD, Cai X, Samuel CS, Ricardo SD, Thomas MC, Kett MM. Does a nephron deficit exacerbate the renal and cardiovascular effects of obesity? PLoS One 2013; 8:e73095. [PMID: 24019901 PMCID: PMC3760915 DOI: 10.1371/journal.pone.0073095] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2013] [Accepted: 07/19/2013] [Indexed: 12/30/2022] Open
Abstract
It has been hypothesized that a reduced nephron endowment exacerbates the hypertensive and renal effects of obesity. We therefore examined the impact of diet-induced obesity on renal structure and function, and arterial pressure in a genetic model of reduced nephron endowment, the GDNF Heterozygous (HET) mouse. 6wk-old male GDNF WT and HET mice were placed on control or high fat (HFF) diet for 20 weeks. 24 hr arterial pressure, heart rate and activity (radiotelemetry), creatinine clearance and albumin excretion were measured, and kidneys collected (histopathology, collagen content). Bodyweights of HFF WT (50.6±1.2 g) and HET (48.8±1.4 g) mice were ∼14 g greater than control mice (37.3±1.3 g, 36.4±1.1 g respectively; Pdiet<0.001). Obesity led to significantly greater 24 hr MAP (Pdiet<0.001), heart rate (Pdiet<0.01) and lower locomotor activity (Pdiet<0.01) in HET and WT mice. Whilst there was no significant impact of genotype on 24 hr MAP response to obesity, night-time MAP of obese HET mice was significantly greater than obese WT mice (122.3±1.6 vs 116.9±1.3 mmHg; P<0.05). 24 hr creatinine clearance was 50%, and albumin excretion 180% greater in obese WT and HET mice compared to controls (Pdiet<0.05) but this response did not differ between genotypes. Obesity induced glomerulomegaly, glomerulosclerosis, tubulointerstitial expansion and increased collagen accumulation (total, collagen I, V and IV; Pdiet<0.001). Obese GDNF HET mice had exacerbated total renal collagen (P<0.01), and greater levels of the collagen I subtype compared to kidneys of obese WT mice. In summary, obese nephron-deficient GDNF HET mice were able to maintain the high creatinine clearances of obese WT mice but at the expense of higher MAP and greater renal fibrosis. Whilst modest, our findings support the hypothesis that a reduced nephron endowment increases the susceptibility to obesity-induced kidney disease and hypertension.
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Affiliation(s)
- Seshini Gurusinghe
- Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Russell D. Brown
- Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Xiaochu Cai
- Department of Physiology, Monash University, Clayton, Victoria, Australia
| | - Chrishan S. Samuel
- Department of Pharmacology, Clayton, Victoria, Australia
- Howard Florey Institute, University of Melbourne, Parkville, Victoria, Australia
- Department of Biochemistry and Molecular Biology, University of Melbourne, Parkville, Victoria, Australia
| | - Sharon D. Ricardo
- Department of Anatomy and Cell Biology, Monash University, Clayton, Victoria, Australia
| | - Merlin C. Thomas
- Baker IDI Heart and Diabetes Institute, Prahran, Victoria, Australia
| | - Michelle M. Kett
- Department of Anatomy and Cell Biology, Monash University, Clayton, Victoria, Australia
- * E-mail:
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Carlström M, Brown RD, Yang T, Hezel M, Larsson E, Scheffer PG, Teerlink T, Lundberg JO, Persson AEG. L-arginine or tempol supplementation improves renal and cardiovascular function in rats with reduced renal mass and chronic high salt intake. Acta Physiol (Oxf) 2013; 207:732-41. [PMID: 23387940 DOI: 10.1111/apha.12079] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2012] [Revised: 01/31/2013] [Accepted: 02/03/2013] [Indexed: 12/23/2022]
Abstract
AIM Early life reduction in nephron number and chronic high salt intake cause development of renal and cardiovascular disease, which has been associated with oxidative stress and nitric oxide (NO) deficiency. We investigated the hypothesis that interventions stimulating NO signalling or reducing oxidative stress may restore renal autoregulation, attenuate hypertension and reduce renal and cardiovascular injuries following reduction in renal mass and chronic high salt intake. METHODS Male Sprague-Dawley rats were uninephrectomized (UNX) or sham-operated at 3 weeks of age and given either a normal-salt (NS) or high-salt (HS) diet. Effects on renal and cardiovascular functions were assessed in rats supplemented with substrate for NO synthase (L-Arg) or a superoxide dismutase mimetic (Tempol). RESULTS Rats with UNX + HS developed hypertension and displayed increased renal NADPH oxidase activity, elevated levels of oxidative stress markers in plasma and urine, and reduced cGMP in plasma. Histological analysis showed signs of cardiac and renal inflammation and fibrosis. These changes were linked with abnormal renal autoregulation, measured as a stronger tubuloglomerular feedback (TGF) response. Simultaneous treatment with L-Arg or Tempol restored cGMP levels in plasma and increased markers of NO signalling in the kidney. This was associated with normalized TGF responses, attenuated hypertension and reduced signs of histopathological changes in the kidney and in the heart. CONCLUSION Reduction in nephron number during early life followed by chronic HS intake is associated with oxidative stress, impaired renal autoregulation and development of hypertension. Treatment strategies that increase NO bioavailability, or reduce levels of reactive oxygen species, were proven beneficial in this model of renal and cardiovascular disease.
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Affiliation(s)
| | | | - T. Yang
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm; Sweden
| | - M. Hezel
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm; Sweden
| | - E. Larsson
- Department of Genetics and Pathology; Uppsala University; Uppsala; Sweden
| | - P. G. Scheffer
- Department of Clinical Chemistry; VU University Medical Centre; Amsterdam; the Netherlands
| | - T. Teerlink
- Department of Clinical Chemistry; VU University Medical Centre; Amsterdam; the Netherlands
| | - J. O. Lundberg
- Department of Physiology and Pharmacology; Karolinska Institutet; Stockholm; Sweden
| | - A. E. G. Persson
- Department of Medical Cell Biology; Uppsala University; Uppsala; Sweden
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Lafranca JA, Hagen SM, Dols LFC, Arends LR, Weimar W, Ijzermans JNM, Dor FJMF. Systematic review and meta-analysis of the relation between body mass index and short-term donor outcome of laparoscopic donor nephrectomy. Kidney Int 2013; 83:931-9. [PMID: 23344469 DOI: 10.1038/ki.2012.485] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
In this era of organ donor shortage, live kidney donation has been proven to increase the donor pool; however, it is extremely important to make careful decisions in the selection of possible live donors. A body mass index (BMI) above 35 is generally considered as a relative contraindication for donation. To determine whether this is justified, a systematic review and meta-analysis were carried out to compare perioperative outcome of live donor nephrectomy between donors with high and low BMI. A comprehensive literature search was performed in MEDLINE, Embase, and CENTRAL (the Cochrane Library). All aspects of the Preferred Reporting Items for Systematic Reviews and Meta-analyses statement were followed. Of 14 studies reviewed, eight perioperative donor outcome measures were meta-analyzed, and, of these, five were not different between BMI categories. Three found significant differences in favor of low BMI (29.9 and less) donors with significant mean differences in operation duration (16.9 min (confidence interval (CI) 9.1-24.8)), mean difference in rise in serum creatinine (0.05 mg/dl (CI 0.01-0.09)), and risk ratio for conversion (1.69 (CI 1.12-2.56)). Thus, a high body mass index (BMI) alone is no contraindication for live kidney donation regarding short-term outcome.
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Affiliation(s)
- Jeffrey A Lafranca
- Department of Surgery, Division of Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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O’Brien B, Mastoridis S, Crane J, Hakim N, Papalois V. Safety of Nephrectomy in Morbidly Obese Donors. EXP CLIN TRANSPLANT 2012; 10:579-85. [DOI: 10.6002/ect.2012.0079] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Khwaja A, El-Nahas M. Transplantation in the obese: separating myth from reality. Nephrol Dial Transplant 2012; 27:3732-5. [DOI: 10.1093/ndt/gfs406] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Serur D, Charlton M. Expanded Criteria Living Donors: How Far Can We Go? Prog Transplant 2012; 22:129-32; quiz 133. [DOI: 10.7182/pit2012244] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
In an effort to expand the deceased donor pool, transplant centers have accepted expanded criteria donors as appropriate for many of the patients in the deceased donor pool. Translating this into the living donor pool is more complex. One must consider not only the quality of the organ procured but the consequences that the nephrectomy might have on the living donors for the rest of their lives. This review examines the available data on higher risk donors and the appropriateness, or lack thereof, of accepting them as kidney donors.
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Affiliation(s)
- David Serur
- New York Presbyterian-Weill Cornell Kidney and Pancreas Transplant Program and The Rogosin Institute
| | - Marian Charlton
- New York Presbyterian-Weill Cornell Kidney and Pancreas Transplant Program and The Rogosin Institute
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Abstract
PURPOSE OF REVIEW Living kidney donors face a unique decision of self-sacrifice that is not without potential risk. The purpose of this review is to highlight existing research regarding the perioperative morbidity, mortality and long-term outcomes of living kidney donors. RECENT FINDINGS Recent studies of long-term donor survival have affirmed that the life expectancy for living kidney donors is excellent and their risk of end-stage renal disease (ESRD) is not increased. Long-term health outcomes for living donors representing minority groups, however, may not be as favorable. Recent studies conclude that African-American and Hispanic donors, similarly to nondonors of the same race, are at higher risk of developing chronic kidney disease (CKD), hypertension, and diabetes mellitus. Outcomes in medically complex donors have also generated considerable attention, and the evidence on outcomes among otherwise healthy obese and older donors appears to be reassuring. SUMMARY Living kidney donation is a superior transplantation option for many individuals with ESRD. The survival and health consequences of living donation have proven to be excellent. These favorable outcomes stem from careful screening measures, and further research endeavors are needed to ensure long-term living donor safety in high-risk donors.
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Delanaye P, Weekers L, Dubois BE, Cavalier E, Detry O, Squifflet JP, Krzesinski JM. Outcome of the living kidney donor. Nephrol Dial Transplant 2012; 27:41-50. [DOI: 10.1093/ndt/gfr669] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023] Open
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50
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Creatinine-based estimations of kidney function are unreliable in obese kidney donors. J Transplant 2012; 2012:872894. [PMID: 22315657 PMCID: PMC3270458 DOI: 10.1155/2012/872894] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2011] [Accepted: 11/07/2011] [Indexed: 12/11/2022] Open
Abstract
Accurate assessment of kidney function by measurement of glomerular filtration rate (GFR) is essential to the risk assessment of prospective living kidney donors. We evaluated the performance of various estimating equations for creatinine clearance (Cockcroft-Gault), GFR (Modification of Diet in Renal Disease, Chronic Kidney Disease Epidemiology Collaboration), and 24-hour urine collections for creatinine clearance in obese potential kidney donors. We evaluated 164 potential kidney donors including 49 with a BMI of 30–35 and 32 with a BMI >35 that have completed a routine living donor evaluation with a measured GFR. All the estimating equations performed poorly in obese donors. While 24-hour urine collections performed better, only 15% had an adequate 24-hour urine collection. Since obese kidney donors may be at higher than average risk for kidney failure, accurate assessment of kidney function in these donors is crucial to ensure their long-term health postdonation.
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