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

Ziad Arabi; Muhammad Bukhari; Abdullah Hamad; Abdulrahman Altheaby; Saleh Kaysi

doi:10.1055/s-0041-1736541

Avicenna Journal of Medicine, Table of Contents

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

Original Article

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

Ziad Arabi

¹Department 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

²Department of Medicine, Division of Adult Nephrology, Taif University, Taif, Saudi Arabia

,

Abdullah Hamad

³Department of Medicine, Division of Nephrology, Regional Medical Center of Orangeburg and Calhoun Counties, Orangeburg, South Carolina, United States

,

Abdulrahman Altheaby

¹Department 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

⁴Department of Medicine, Division of Nephrology, CHU, Clermont-Ferrand, France

› Author Affiliations

Abstract

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

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

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

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

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

Keywords

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

Full Text

References

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