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Quint EE, Westenberg LB, Nieuwenhuijs-Moeke GJ, van den Broek EAN, Zorgdrager M, Viddeleer AR, Bakker SJL, Nolte IM, van Londen M, Pol RA, TransplantLines Investigators. Analyzing body composition in living kidney donors: impact on post-transplant kidney function. FRONTIERS IN NEPHROLOGY 2024; 4:1467669. [PMID: 39654905 PMCID: PMC11625803 DOI: 10.3389/fneph.2024.1467669] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/20/2024] [Accepted: 11/01/2024] [Indexed: 12/12/2024]
Abstract
Living donor kidney transplantation boasts superior patient and graft survival rates compared to deceased donor kidney transplantation. However, the impact of living donor body composition (BC) on post-transplant kidney function remains uncertain. In a cohort of 293 living kidney donor-recipients pairs, we utilized linear mixed model analyses, adjusted for time and including a multiplicative interaction term of time with the donor body composition measure, and found no significant associations between any donor BC measure and the annual change in recipient post-transplantation estimated glomerular filtration rate (eGFR) [donor body mass index (BMI): B=-0.01, 95%CI -0.13; 0.11, p=0.88; donor waist circumference: B=0.02, 95%CI -0.02; 0.06, p=0.38; donor skeletal muscle index: B=-0.02, 95%CI -0.07; 0.04, p=0.63; donor skeletal muscle radiation attenuation: B=-0.002, 95%CI -0.06; 0.06, p=0.96; donor visceral adipose tissue index: B=-0.001, 95%CI -0.02; 0.02, p=0.93; donor subcutaneous adipose tissue index: B=-0.001, 95%CI -0.02; 0.02, p=0.94; donor intramuscular adipose tissue index: B=-0.12, 95%CI -0.29; 0.06, p=0.19; donor total abdominal adipose tissue index: B=-0.001, 95%CI -0.01; 0.01, p=0.89]. Our study suggests that pre-donation BC does not affect post-transplantation recipient eGFR in donor populations with a BMI below 35 kg/m2.
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Affiliation(s)
- Evelien E. Quint
- Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Lisa B. Westenberg
- Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | | | - Eva A. N. van den Broek
- Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marcel Zorgdrager
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Alain R. Viddeleer
- Department of Radiology, Medical Imaging Center, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Stephan J. L. Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ija M. Nolte
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Marco van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Robert A. Pol
- Department of Surgery, Division of Transplantation Surgery, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - TransplantLines Investigators
- Department of Internal Medicine, Division of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
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Trevisani F, Floris M, Trepiccione F, Rosiello G, Capasso G, Pani A, Maculan M, Mascia G, Silvestre C, Bettiga A, Cinque A, Capitanio U, Larcher A, Briganti A, Salonia A, Rigotti P, Montorsi F, Angioi A, Furian L. Surgery or Comorbidities: What Is the Primum Movens of Kidney Dysfunction After Nephrectomy? A Multicenter Study in Living Donors and Cancer Patients. J Clin Med 2024; 13:6551. [PMID: 39518690 PMCID: PMC11547066 DOI: 10.3390/jcm13216551] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2024] [Revised: 10/23/2024] [Accepted: 10/26/2024] [Indexed: 11/16/2024] Open
Abstract
Background and Hypothesis: Acute Kidney Injury (AKI) and Chronic Kidney Disease (CKD) are significant risks for kidney cancer (KC) patients undergoing partial (PN) or radical nephrectomy (RN) and for living kidney donors (LKD). This study compares AKI and CKD incidence in these groups with a pre-operative glomerular filtration rate (GFR) over 60 mL/min/1.73 m2. Methods: This study included 465 KC patients with cT1-2N0M0 kidney mass and 256 LKD who underwent nephrectomy at four Italian institutions from 2014 to 2021. Data on demographics, comorbidities, and therapies were analyzed. Serum creatinine and estimated GFR (eGFR) were measured before and after surgery. Outcomes were AKI (per KDIGO guidelines) and CKD stage progression. Analyses included descriptive statistics, ANOVA, logistic regression, and Kaplan-Meier survival. Results: Among 721 patients, significant age and gender differences were noted. Hypertension (41%) and diabetes (7.1%) were prevalent in RN and PN groups. Post-surgery AKI was more common in donors (84%), while CKD stage progression varied by surgery type (CKD stage G3 after 60 months: RN 48.91%, PN 18.22%, LKD 26.56%). Age, pre-surgery CKD, and surgery type predicted CKD progression. Limitations include retrospective design and bias. Conclusions: Both LKD and KC patients face similar AKI and CKD risks. Surgery type significantly influences AKI and CKD incidence, highlighting the importance of approach.
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Affiliation(s)
- Francesco Trevisani
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
- Biorek srl, San Raffaele Scientific Institute, 20132 Milan, Italy;
| | - Matteo Floris
- Department of Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, 09134 Cagliari, Italy; (M.F.); (A.P.); (G.M.); (A.A.)
| | - Francesco Trepiccione
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.T.); (G.C.)
| | - Giuseppe Rosiello
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Giovambattista Capasso
- Department of Translational Medical Sciences, University of Campania “Luigi Vanvitelli”, 80138 Naples, Italy; (F.T.); (G.C.)
| | - Antonello Pani
- Department of Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, 09134 Cagliari, Italy; (M.F.); (A.P.); (G.M.); (A.A.)
| | - Marco Maculan
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, 35122 Padova, Italy; (M.M.); (C.S.); (L.F.)
| | - Giacomo Mascia
- Department of Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, 09134 Cagliari, Italy; (M.F.); (A.P.); (G.M.); (A.A.)
| | - Cristina Silvestre
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, 35122 Padova, Italy; (M.M.); (C.S.); (L.F.)
| | - Arianna Bettiga
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
| | | | - Umberto Capitanio
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alessandro Larcher
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Alberto Briganti
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Andrea Salonia
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Paolo Rigotti
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Francesco Montorsi
- Division of Experimental Oncology, Urological Research Institute, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy; (G.R.); (A.B.); (U.C.); (A.L.); (A.B.); (A.S.); (P.R.); (F.M.)
- Department of Urology, IRCCS San Raffaele Scientific Institute, Vita-Salute San Raffaele University, 20132 Milan, Italy
| | - Andrea Angioi
- Department of Nephrology, Dialysis, and Transplantation, G. Brotzu Hospital, 09134 Cagliari, Italy; (M.F.); (A.P.); (G.M.); (A.A.)
| | - Lucrezia Furian
- Kidney and Pancreas Transplantation Unit, Department of Surgical, Oncological and Gastroenterological Sciences, University of Padova, 35122 Padova, Italy; (M.M.); (C.S.); (L.F.)
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Evans MD, Helgeson ES, Rule AD, Vock DM, Matas AJ. Consequences of low estimated glomerular filtration rate either before or early after kidney donation. Am J Transplant 2024; 24:1816-1827. [PMID: 38878866 PMCID: PMC11439579 DOI: 10.1016/j.ajt.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/20/2024] [Accepted: 04/20/2024] [Indexed: 07/11/2024]
Abstract
In the general population, decreases in glomerular filtration rate (GFR) are associated with subsequent development of chronic kidney disease (CKD), cardiovascular disease (CVD), and death. It is unknown if low estimated GFR (eGFR) before or early after kidney donation was also associated with these risks. One thousand six hundred ninety-nine living donors who had both predonation and early (4-10 weeks) postdonation eGFR were included. We studied the relationships between eGFR, age at donation, and the time to sustained eGFR<45 (CKD stage 3b) and <30 mL/min/1.73m2 (CKD stage 4), hypertension, diabetes mellitus (DM), CVD, and death. Median follow-up was 12 (interquartile range, 6-21) years. Twenty-year event rates were 5.8% eGFR<45 mL/min/1.73m2; 1.2% eGFR<30 mL/min/1.73m2; 29.0% hypertension; 7.8% DM; 8.0% CVD; and 5.2% death. The median time to eGFR<45 mL/min/1.73m2 (N = 79) was 17 years, and eGFR<30 mL/min/1.73m2 (N = 22) was 25 years. Both low predonation and early postdonation eGFR were associated with eGFR<45 mL/min/1.73m2 (P < .0001) and eGFR<30 mL/min/1.73m2 (P < .006); however, the primary driver of risk for all ages was low postdonation (rather than predonation) eGFR. Predonation and postdonation eGFR were not associated with hypertension, DM, CVD, or death. Low predonation and early postdonation eGFR are risk factors for developing eGFR<45 mL/min/1.73m2 (CKD stage 3b) and <30 mL/min/1.73m2 (CKD stage 4), but not CVD, hypertension, DM, or death.
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Affiliation(s)
- Michael D Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erika S Helgeson
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Vock
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Hirose T, Hotta K, Osawa T, Yokota I, Inao T, Tanabe T, Iwahara N, Shinohara N. Longitudinal mortality risks and kidney functional outcomes in Japanese living kidney donors. Int J Urol 2024; 31:519-524. [PMID: 38240161 DOI: 10.1111/iju.15395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/04/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Previous studies suggested that living kidney donors do not have a higher risk of death or kidney failure than the general population. However, living kidney donor risk is controversial. Furthermore, only a few studies have evaluated long-term kidney function after kidney donation. METHODS This study evaluated Japanese kidney donor' long-term outcomes, including mortality and kidney function. From 1965 to 2015, 230 donors (76 males, 154 females, and a median age of 54) were enrolled in this study. The median observation period was 11.0 (range, 0.3-41.0) years. RESULTS In total, 215 donors were still alive, and 15 had died. Causes of death included malignancies, cardiovascular disease, pneumonia, suicide, gastrointestinal bleeding, and kidney failure. Actual donor survival rates at 10, 20, and 30 years were 95.3%, 90.7%, and 80.9%, respectively. These values were comparable to age- and gender-matched expected survival. Long-term kidney function after donation was evaluated in 211 donors with serum creatinine data. Two donors developed kidney failure 24 and 26 years post-donation, respectively. The percentage of donors whose estimated glomerular filtration rate (eGFR) remained ≥45 mL/min/1.73 m2 at 10, 20, and 30 years after donation were 84.2%, 73.0%, and 63.9%, respectively. Survival rates of donors with eGFR <45 mL/min/1.73 m2 were comparable to those in persons with eGFR >45 mL/min/1.73 m2. CONCLUSION Our findings revealed that kidney donors did not have a higher long-term risk of death than the general population. Although some donors showed decreased kidney function after donation, kidney function did not impact their survival.
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Affiliation(s)
- Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tasuku Inao
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Naoya Iwahara
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
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Perry J, McLeod MC, Reed RD, Baker GA, Stanford LA, Allen J, Jones B, Robinson T, MacLennan PA, Kumar V, Locke JE. Patient-Level and Center-Level Factors Associated with Required Predonation Weight Loss among Obese Living Kidney Donors. KIDNEY360 2024; 5:437-444. [PMID: 38319632 PMCID: PMC11000741 DOI: 10.34067/kid.0000000000000381] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Accepted: 01/29/2024] [Indexed: 02/07/2024]
Abstract
Key Points Among obese living kidney donors, year of donation, preoperative body mass index, hypertension, and center percent of living kidney donor transplants were associated with required predonation weight loss. There were no significant differences in the likelihood of predonation weight loss requirement by race, sex, or age or by markers of preoperative metabolic dysfunction. Background The proportion of overweight/mildly obese living kidney donors (OLKDs) has increased in the past few decades, with significant center variation in the body mass index (BMI) of LKDs. The purpose of this study was to examine factors associated with required predonation weight loss among OLKDs (BMI, ≥30 kg/m2). Methods This retrospective cohort study surveyed 1097 OLKDs (1979–2020) (mean BMI, 33 kg/m2) about their donation experience. Bivariate analyses compared donor demographic and center characteristics by whether the donor reported predonation weight loss requirement. Generalized estimating equations with logit link were used to estimate marginal effects of patient-level and center-level factors. Multiple imputation using chained equations was implemented to account for missing values. Results Of 1097 OLKDs surveyed, 340 (31.0%) reported predonation weight loss requirement. Donors with a predonation weight loss requirement had slightly higher predonation BMIs and donated in more recent years at centers performing a lower percentage of living donor nephrectomies and with a lower median BMI. In multivariable logistic regression analysis, we observed transplant year (odds ratio [OR], 1.04 per year donation; 95% confidence interval [CI], 1.01 to 1.07; P = 0.005), preoperative BMI (OR, 1.16; 95% CI, 1.05 to 1.28; P < 0.01), preoperative hypertension (OR, 1.61; 95% CI, 1.08 to 2.40; P = 0.02), and center percentage of living donor kidney transplants (OR, 0.99; 95% CI, 0.98 to 1.00; P = 0.02) as significantly associated with a predonation weight loss requirement. The study found no differences in the likelihood of predonation weight loss requirement by race, sex, age, preoperative creatinine, preoperative metabolic dysfunction, or center-level median BMI of living donors. Conclusions These results suggest that both center-level and patient-level factors influence whether OLKDs are required to lose weight before donation. Future study is needed to determine whether predonation weight loss is associated with improved long-term postdonation outcomes.
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Affiliation(s)
- Jackson Perry
- University of Alabama Comprehensive Transplant Institute, Birmingham, Alabama
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Orandi BJ, Lofton H, Montgomery RA, Segev DL. Antiobesity pharmacotherapy to facilitate living kidney donation. Am J Transplant 2024; 24:328-337. [PMID: 38072121 DOI: 10.1016/j.ajt.2023.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Revised: 12/02/2023] [Accepted: 12/04/2023] [Indexed: 12/27/2023]
Abstract
Obesity is a chronic, relapsing disease that increases the risks of living kidney donation; at the same time, transplant centers have liberalized body mass index constraints for donors. With the increasing number of antiobesity medications available, the treatment of obesity with antiobesity medications may increase the pool of potential donors and enhance donor safety. Antiobesity medications are intended for long-term use given the chronic nature of obesity. Cessation of treatment can be expected to lead to weight regain and increase the risk of comorbidity rebound/development. In addition, antiobesity medications are meant to be used in conjunction with-rather than in replacement of-diet and physical activity optimization. Antiobesity medication management includes selecting medications that may ameliorate any coexisting medical conditions, avoiding those that are contraindicated in such conditions, and being sensitive to any out-of-pocket expenses that may be incurred by the potential donor. A number of questions remain regarding who will and should shoulder the costs of long-term obesity treatment for donors. In addition, future studies are needed to quantify the degree of weight loss and duration of weight loss maintenance needed to normalize the risk of adverse kidney outcomes relative to comparable nondonors and lower-weight donors.
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Affiliation(s)
- Babak J Orandi
- New York University Department of Surgery, New York, New York, USA; New York University Department of Medicine, New York, New York, USA.
| | - Holly Lofton
- New York University Department of Medicine, New York, New York, USA
| | | | - Dorry L Segev
- New York University Department of Surgery, New York, New York, USA; New York University Department of Population Health, New York, New York, USA
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van Buren MC, Meinderts JR, Oudmaijer CAJ, de Jong MFC, Groen H, Royaards T, Maasdam L, Tielen M, Reinders MEJ, Lely AT, van de Wetering J. Long-Term Kidney and Maternal Outcomes After Pregnancy in Living Kidney Donors. Transpl Int 2023; 36:11181. [PMID: 37448449 PMCID: PMC10337757 DOI: 10.3389/ti.2023.11181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023]
Abstract
For counseling it is important to know if pregnancy after Living Kidney Donation (LKD) affects long-term outcomes of the mono-kidney and the mother. Therefore, we performed a retrospective multicenter study in women ≤45 years who donated their kidney between 1981 and 2017. Data was collected via questionnaires and medical records. eGFR of women with post-LKD pregnancies were compared to women with pre-LKD pregnancies or nulliparous. eGFR before and after pregnancy were compared in women with post-LKD pregnancies. Pregnancy outcomes post-LKD were compared with pre-LKD pregnancy outcomes. 234 women (499 pregnancies) were included, of which 20 with pre- and post-LKD pregnancies (68) and 26 with only post-LKD pregnancies (59). Multilevel analysis demonstrated that eGFR was not different between women with and without post-LKD pregnancies (p = 0.23). Furthermore, eGFR was not different before and after post-LKD pregnancy (p = 0.13). More hypertensive disorders of pregnancy (HDP) occurred in post-LKD pregnancies (p = 0.002). Adverse fetal outcomes did not differ. We conclude that, despite a higher incidence of HDP, eGFR was not affected by post-LKD pregnancy. In line with previous studies, we found an increased risk for HDP after LKD without affecting fetal outcome. Therefore, a pregnancy wish alone should not be a reason to exclude women for LKD.
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Affiliation(s)
- Marleen C. van Buren
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Jildau R. Meinderts
- Department of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Christiaan A. J. Oudmaijer
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | | | - Henk Groen
- Department of Epidemiology, University of Groningen, Groningen, Netherlands
| | - Tessa Royaards
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Louise Maasdam
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Mirjam Tielen
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Marlies E. J. Reinders
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - A. Titia Lely
- Department of Obstetrics, Wilhelmina Children’s Hospital Birth Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
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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: 0.7] [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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9
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Matas AJ, Rule AD. Long-term Medical Outcomes of Living Kidney Donors. Mayo Clin Proc 2022; 97:2107-2122. [PMID: 36216599 PMCID: PMC9747133 DOI: 10.1016/j.mayocp.2022.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022]
Abstract
Historically, to minimize risks, living kidney donors have been highly selected and healthy. Operative risks are well-defined, yet concern remains about long-term risks. In the general population, even a mild reduction in glomerular filtration rate (GFR) is associated with cardiovascular disease, chronic kidney disease, and end-stage kidney disease (ESKD). However, reduction in GFR in the general population is due to kidney or systemic disease. Retrospective studies comparing donors with matched general population controls have found no increased donor risk. Prospective studies comparing donors with controls (maximum follow-up, 9 years) have reported that donor GFR is stable or increases slightly, whereas GFR decreases in controls. However, these same studies identified metabolic and vascular donor abnormalities. There are a few retrospective studies comparing donors with controls. Each has limitations in selection of the control group, statistical analyses, and/or length of follow-up. One such study reported increased donor mortality; 2 reported a small increase in absolute risk of ESKD. Risk factors for donor ESKD are similar to those in the general population. Postdonation pregnancies are also associated with increased risk of hypertension and preeclampsia. There is a critical need for long-term follow-up studies comparing donors with controls from the same era, geographic area, and socioeconomic status who are healthy, with normal renal function on the date matching the date of donation, and are matched on demographic characteristics with the donors. These data are needed to optimize donor candidate counseling and informed consent.
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Affiliation(s)
- Arthur J Matas
- Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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10
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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: 16] [Impact Index Per Article: 5.3] [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)
| | | | - 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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11
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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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12
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Kher V, Kute VB, Sahariah S, Ray DS, Khullar D, Guleria S, Bansal S, Gang S, Bhalla AK, Prakash J, Abraham A, Shroff S, Bahadur MM, Das P, Anandh U, Chaudhury AR, Singhal M, Kothari J, Raju SB, Pahari DK, Siddini GV, Sudhakar G, Varughese S, Saha TK. Clinical Perspectives towards Improving Risk Stratification Strategy for Renal Transplantation Outcomes in Indian Patients. INDIAN JOURNAL OF TRANSPLANTATION 2022; 16:145-154. [DOI: 10.4103/ijot.ijot_28_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Graft loss and rejections (acute/chronic) continue to remain important concerns in long-term outcomes in kidney transplant despite newer immunosuppressive regimens and increased use of induction agents. Global guidelines identify the risk factors and suggest a framework for management of patients at different risk levels for rejection; however, these are better applicable to deceased donor transplants. Their applicability in Indian scenario (predominantly live donor program) could be a matter of debate. Therefore, a panel of experts discussed the current clinical practice and adaptability of global recommendations to Indian settings. They also took a survey to define risk factors in kidney transplants and provide direction toward evidence- and clinical experience-based risk stratification for donor/recipient and transplant-related characteristics, with a focus on living donor transplantations. Several recipient related factors (dialysis, comorbidities, and age, donor-specific antibodies [DSAs]), donor-related factors (age, body mass index, type – living or deceased) and transplantation related factors (cold ischemia time [CIT], number of transplantations) were assessed. The experts suggested that immunological conflict should be avoided by performing cytotoxic cross match, flow cross match in all patients and DSA-(single antigen bead) whenever considered clinically relevant. HLA mismatches, presence of DSA, along with donor/recipient age, CIT, etc., were associated with increased risk of rejection. Furthermore, the panel agreed that the risk of rejection in living donor transplant is not dissimilar to deceased donor recipients. The experts also suggested that induction immunosuppression could be individualized based on the risk stratification.
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13
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Ibrahim HN, Murad DN, Hebert SA, Adrogue HE, Nguyen H, Nguyen DT, Matas AJ, Graviss EA. Intermediate Renal Outcomes, Kidney Failure, and Mortality in Obese Kidney Donors. J Am Soc Nephrol 2021; 32:2933-2947. [PMID: 34675059 PMCID: PMC8806092 DOI: 10.1681/asn.2021040548] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 08/04/2021] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Obesity is associated with the two archetypal kidney disease risk factors: hypertension and diabetes. Concerns that the effects of diabetes and hypertension in obese kidney donors might be magnified in their remaining kidney have led to the exclusion of many obese candidates from kidney donation. METHODS We compared mortality, diabetes, hypertension, proteinuria, reduced eGFR and its trajectory, and the development of kidney failure in 8583 kidney donors, according to body mass index (BMI). The study included 6822 individuals with a BMI of <30 kg/m2, 1338 with a BMI of 30-34.9 kg/m2, and 423 with a BMI of ≥35 kg/m2. We used Cox regression models, adjusting for baseline covariates only, and models adjusting for postdonation diabetes, hypertension, and kidney failure as time-varying covariates. RESULTS Obese donors were more likely than nonobese donors to develop diabetes, hypertension, and proteinuria. The increase in eGFR in obese versus nonobese donors was significantly higher in the first 10 years (3.5 ml/min per 1.73m2 per year versus 2.4 ml/min per 1.73m2 per year; P<0.001), but comparable thereafter. At a mean±SD follow-up of 19.3±10.3 years after donation, 31 (0.5%) nonobese and 12 (0.7%) obese donors developed ESKD. Of the 12 patients with ESKD in obese donors, 10 occurred in 1445 White donors who were related to the recipient (0.9%). Risk of death in obese donors was not significantly increased compared with nonobese donors. CONCLUSIONS Obesity in kidney donors, as in nondonors, is associated with increased risk of developing diabetes and hypertension. The absolute risk of ESKD is small and the risk of death is comparable to that of nonobese donors.
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Affiliation(s)
| | - Dina N. Murad
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Sean A. Hebert
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | | | - Hana Nguyen
- Department of Medicine, Houston Methodist Hospital, Houston, Texas
| | - Duc T. Nguyen
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
| | - Arthur J. Matas
- Department of Surgery, University of Minnesota, Minneapolis, Minnesota
| | - Edward A. Graviss
- Department of Pathology and Genomic Medicine, Institute for Academic Medicine, Houston Methodist Research Institute, Houston, Texas
- Department of Surgery, Houston Methodist Hospital, Houston, Texas
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14
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Reza-Escalera AL, Tiscareño-Gutiérrez MT, Ovalle-Robles I, Macias-Guzmán MJ, Garcia-Díaz AL, Gutierrez-Peña CM, Chew-Wong A, Ricalde-Ríos G, Romo-Franco L, Reyes-Acevedo R, Galvan-Guerra E, Lagunas-Rodríguez AB, Delgado-Beltran MI, Rojas-Terán JF, Delgadillo-Castañeda R, Macias-Diaz DM, Alberu-Gomez J, Arreola-Guerra JM. Chronic Kidney Disease Risk Profile in Renal Donors in Aguascalientes, Mexico: A Retrospective Cohort Study. Transplant Proc 2021; 54:1701-1706. [PMID: 34756716 DOI: 10.1016/j.transproceed.2021.09.036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 09/27/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND In the last decade, kidney donation has been recognized as a risk factor for end-stage renal disease (ESRD). ESRD risk calculators have been recently perfected in North American populations. In Mexico, the rates of overweight, obesity, and diabetes mellitus (DM) are among the highest worldwide; nevertheless, most kidney transplants are obtained from living donors. This study aims to describe the risk profile for chronic kidney disease (CKD) development in kidney donors in a highly active transplant center in Central Mexico. METHODS We conducted a retrospective, observational, descriptive cohort study of kidney donors followed at the Hospital Centenario Miguel Hidalgo (CHMH). We used the pretransplant CKD risk calculator at 15 years and over a lifetime (www.transplantmodels.com/esrdrisk). Aside from the calculator of kidney failure risk, we also used the calculator for postdonation CKD risk (www.transplantmodels.com/donesrd/). Factors associated with a glomerular filtration rate (GFR) <60 mL/min were evaluated by univariate and multivariate analysis. RESULTS The study included 543 donors. The average follow-up period was 1.7 years (±2.7) with a median of 0.7 years (interquartile range, 0.2-2.1). The average predicted risk for ESRD development at 15 years was 0.08% (±0.1); 25.6% had a risk >0.1%, and only 1 patient had a risk >1%. The lifetime ESRD risk was 0.62% (±0.5); 15% had a risk >1%, and the greatest risk was 3.5%. The median of patients at risk of developing postdonation ESRD was 1 in 10,000 donors (0.6-1.5) at 5 years, 5.7 in 10,000 donors (3.5-8.8) at 10 years, 15 in 10,000 donors (9.1-23.2) at 15 years, and 31 in 10,000 donors (18.9-47.7) at 20 years. During the follow-up period, 52 patients developed a GFR of <60 mL/min. Both risk estimation formulas were significantly associated with a GFR of <60 mL/min. Among the individual factors, the GFR (hazard ratio 0.96, 95% confidence interval 0.94-0.97, P < .001) and the urinary albumin to creatinine ratio (hazard ratio 1.009, 95% confidence interval 1.005-1.01, P < .001) remained statistically significant. CONCLUSION The risk of ESRD in kidney donors in Aguascalientes, Mexico, is similar to that described in the United States. Risk calculators are an indispensable decision-making tool to better understand kidney donors in our milieu.
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Affiliation(s)
| | | | - Itzel Ovalle-Robles
- Nephrology Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | | | | | | | - Alfredo Chew-Wong
- Nephrology Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | | | - Luis Romo-Franco
- Transplantation Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | - Rafael Reyes-Acevedo
- Transplantation Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico
| | | | | | | | | | | | | | - Josefina Alberu-Gomez
- Tecnológico de Monterrey, Escuela de Medicina y Ciencias de la Salud, Monterrey, Mexico
| | - Jose Manuel Arreola-Guerra
- Nephrology Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico; Internal Medicine Department, Centenario Hospital Miguel Hidalgo, Aguascalientes, Mexico.
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15
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Veroux M, Mattone E, Cavallo M, Gioco R, Corona D, Volpicelli A, Veroux P. Obesity and bariatric surgery in kidney transplantation: A clinical review. World J Diabetes 2021; 12:1563-1575. [PMID: 34630908 PMCID: PMC8472502 DOI: 10.4239/wjd.v12.i9.1563] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Revised: 06/30/2021] [Accepted: 08/09/2021] [Indexed: 02/06/2023] Open
Abstract
Obesity is increasing worldwide, and this has major implications in the setting of kidney transplantation. Patients with obesity may have limited access to transplantation and increased posttransplant morbidity and mortality. Most transplant centers incorporate interventions aiming to target obesity in kidney transplant candidates, including dietary education and lifestyle modifications. For those failing nutritional restriction and medical therapy, the use of bariatric surgery may increase the transplant candidacy of patients with obesity and end-stage renal disease (ESRD) and may potentially improve the immediate and late outcomes. Bariatric surgery in ESRD patients is associated with weight loss ranging from 29.8% to 72.8% excess weight loss, with reported mortality and morbidity rates of 2% and 7%, respectively. The most commonly performed bariatric surgical procedures in patients with ESRD and in transplant patients are laparoscopic sleeve gastrectomy (LSG) and laparoscopic Roux-en-Y gastric bypass. However, the correct timing of bariatric surgery and the ideal type of surgery have yet to be determined, although pretransplant LSG seems to be associated with an acceptable risk-benefit profile. We review the impact of obesity on kidney transplant candidates and recipients and in potential living kidney donors, exploring the potential impact of bariatric surgery in addressing obesity in these populations, thereby potentially improving posttransplant outcomes.
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Affiliation(s)
- Massimiliano Veroux
- Department of Medical and Surgical Sciences and Advanced Technologies GF Ingrassia, University of Catania, Catania 95123, Italy
| | - Edoardo Mattone
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania 95123, Italy
| | - Matteo Cavallo
- Vascular Surgery and Organ Transplant Unit, University Hospital of Catania, Catania 95123, Italy
| | - Rossella Gioco
- General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
| | - Daniela Corona
- General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
| | - Alessio Volpicelli
- General Surgery Unit, University Hospital of Catania, Catania 95123, Italy
| | - Pierfrancesco Veroux
- Department of General Surgery and Medical Specialities, University of Catania, Catania 95123, Italy
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16
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Branchereau J, Prudhomme T, Bessede T, Verhoest G, Boissier R, Culty T, Matillon X, Defortescu G, Sallusto F, Terrier N, Drouin S, Karam G, Badet L, Timsit MO. [Living donor nephrectomy: The French guidelines from CTAFU]. Prog Urol 2021; 31:50-56. [PMID: 33423748 DOI: 10.1016/j.purol.2020.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/29/2020] [Revised: 03/30/2020] [Accepted: 03/31/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To propose surgical recommendations for living donor nephrectomy. METHOD Following a systematic approach, a review of the literature (Medline) was conducted by the CTAFU regarding functional and anatomical assessment of kidney donors, including which side the kidney should be harvested from. Distinct surgical techniques and approaches were evaluated. References were considered with a predefined process to propose recommendations with the corresponding levels of evidence. RESULTS The recommendations clarify the legal and regulatory framework for kidney donation in France. A rigorous assessment of the donor is one of the essential prerequisites for donor safety. The impact of nephrectomy on kidney function needs to be anticipated. In case of modal vascularization of both kidneys without a relative difference in function or urologic abnormality, removal of the left kidney is the preferred choice to favor a longer vein. Mini-invasive approaches for nephrectomy provide faster donor recovery, less donor pain and shorter hospital stay than open surgery. CONCLUSION These French recommendations must contribute to improving surgical management of candidates for kidney donation.
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Affiliation(s)
- J Branchereau
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - T Prudhomme
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - T Bessede
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de Bicêtre, université de Paris-Saclay, 78, rue du Général-Leclerc, 94270 Le Kremlin-Bicêtre, France
| | - G Verhoest
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, hôpital Pontchaillou, CHU de Rennes, 2, rue Henri-le-Guilloux, 35000 Rennes, France
| | - R Boissier
- Service d'urologie et transplantation, hôpital de La Conception, université Aix-Marseille, 47, boulevard Baille, 13005 Marseille, France
| | - T Culty
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation rénale, CHU d'Angers, 4, rue Larrey, 49100 Angers, France
| | - X Matillon
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - G Defortescu
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Rouen, 37, boulevard Gambetta, 76000 Rouen, France
| | - F Sallusto
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Toulouse, avenue du Pr-Jean-Poulhès, 31059 Toulouse, France
| | - N Terrier
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU Grenoble Alpes, boulevard de la Chantourne, 38700 La Tronche, France
| | - S Drouin
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital de la Pitié-Salpêtrière, université Paris Sorbonne, 47, boulevard de l'Hôpital, 75013 Paris, France
| | - G Karam
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, CHU de Nantes, 5, allée de lÎle-Gloriette, 44093 Nantes cedex 01, France
| | - L Badet
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; Service d'urologie et transplantation, hôpital Édouard-Herriot, 5, place d'Arsonval, 69003 Lyon, France
| | - M-O Timsit
- Comité de transplantation et d'insuffisance rénale chronique de l'Association française d'urologie (CTAFU), maison de l'urologie, 11, rue Viète, 75017 Paris, France; PARCC, INSERM, équipe labellisée par la Ligue Contre le Cancer, 56, rue Leblanc, université de Paris, 75015 Paris, France; Service d'urologie et transplantation rénale, hôpital européen Georges-Pompidou, hôpital Necker, Assistance publique-Hôpitaux de Paris, 20, rue Leblanc, 75015 Paris, France.
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17
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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: 0.8] [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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18
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Park JJ, Kim K, Choi JY, Shim SR, Kim JH. Long-term mortality of living kidney donors: a systematic review and meta-analysis. Int Urol Nephrol 2021; 53:1563-1581. [PMID: 33959847 DOI: 10.1007/s11255-021-02854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND To date, several studies have reported inconsistent findings regarding the mortality risk faced by living kidney donors and controls. Our study assessed the methodological quality of previous studies and performed an updated meta-analysis of the mortality risk. METHODS Comprehensive literature searches were conducted involving the PubMed, Embase, and Cochrane databases through September 2020. The search terms used included 'living donor' and 'kidney transplantation' and 'kidney donor' and 'mortality' or 'death' or 'survival'. We evaluated the risk of bias in such studies using ROBINS-I tool. Mortality risk was analyzed using OR and HR. RESULTS The qualitative review involved 18 studies and the meta-analysis included nine studies. We identified 3 studies with an overall risk of bias rated as "Low", 2 studies rated as "Moderate", 8 studies rated as "Serious", and 5 studies rated as "Critical". The pooled overall mortality risk in the meta-analysis was 0.984 (95% CI: 0.743, 1.302). In the subgroup analysis of HR and OR, the summary effect estimates did not reach statistical significance. The meta-regression analysis revealed that the donor group of more than 60,000 (1.836, 95% CI: 0.371, 6.410) carried a significantly high mortality risk compared with the donor group of less than 60,000 (0.810, 95% CI: 0.604, 1.086) (P = 0.007). The number of total patients was associated with slightly elevated mortality risks (0.796 for < 10,000, 0.809 for 10,000-60,000, and 1.852 for > 60,000; P < .054). CONCLUSIONS Current evidence based on this systematic review suggests that the methodology of previous studies was inconsistent and also carried a high risk in several aspects. Updated meta-analysis showed that the mortality risk was not significantly different. Future studies with well-designed methodology are necessary.
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Affiliation(s)
- Jae Joon Park
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Kyeongmin Kim
- INTO Newton A-Level, University of East Anglia, Norwich, UK
| | - Jin Yong Choi
- Department of Surgery, Myongji Hospital, Goyang, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Anamdong 5Ga, Seongbuk-gu, Seoul, 136-701, Korea.
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea.
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One size does not fit all: understanding individual living kidney donor risk. Pediatr Nephrol 2021; 36:259-269. [PMID: 31897715 PMCID: PMC7815560 DOI: 10.1007/s00467-019-04456-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2019] [Revised: 11/25/2019] [Accepted: 12/13/2019] [Indexed: 01/06/2023]
Abstract
Living donor kidney transplantation is the optimal treatment for end-stage kidney disease (ESKD) but confers a risk upon the donor, both in the short term and many years after donation. While perioperative mortality is low and longevity does not appear to be adversely affected, there are small increases in the risk of other important morbidities. The overall risk of ESKD among donors is low but appears to be three- to five-fold higher than among healthy non-donors, and this relative risk is even higher among donors of African ancestry. For these individuals, apolipoprotein L1 genotyping may be helpful. Kidney donors also have an increased risk of developing hypertension post-donation and a modestly increased risk of developing gout. Living kidney donation also increases the risk of gestational hypertension and preeclampsia while not affecting other important pregnancy outcomes. As our understanding of donor risk grows, it is important to counsel prospective donors according to their individual risk and so obtain better informed donor consent. As knowledge advances, it is also important that all clinicians who manage kidney transplant candidates have an up to date understanding of donor risk to inform shared decision making.
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Abstract
PURPOSE OF REVIEW Although the first successful kidney transplantation 65 years ago was performed with a living donor kidney, the number of living donor kidney transplantations has increased especially during the last 2 decades. The enlargement of living donor programs was made possible by new modes of living donation and by expansion of the living donor pool. At the same time, the long-term risks of kidney donation have been better delineated. In this review, the latest developments on these topics are summarized. RECENT FINDINGS While the results of ABO-incompatible living kidney transplantation are superior to those of deceased donor transplantation, recent meta-analyses show a reduced patient and graft survival as compared with ABO compatible transplantation as well as increased risk of severe infection and bleeding. Kidney paired donation programs can be extended by including compatible couples and by advanced donation, although the latter raises ethical concerns. Living donors appear to have a higher risk of end-stage renal disease and this is especially true for obese donors and probably also for black donors with an APOL1 high-risk genotype. The importance of psychosocial outcomes after living kidney donation is increasingly recognized. SUMMARY Living donor kidney transplantation remains the optimal treatment option for patients with end-stage renal disease. To increase the donor pool, a well developed paired kidney donation program and sufficient reimbursement of costs associated with donation are essential ingredients. Other ways of expanding the donor pool, such as ABO-incompatible transplantation, use of higher risk donors, providing donors with financial incentives and advanced donation are associated with medical, ethical and logistical complications. There should be a careful selection and follow-up of living kidney donors with attention for medical consequences as well as for psychosocial outcomes.
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21
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The need for a living donor wellness program. Curr Opin Organ Transplant 2020; 25:311-315. [PMID: 32487890 DOI: 10.1097/mot.0000000000000779] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
PURPOSE OF REVIEW Living donation has a tremendous impact in bridging the gap between the shortage of organs and the growing list of transplant candidates but remains underutilized as a percentage of total transplants performed. This review focuses on obesity and social determinants of health as potential barriers to the expansion of living kidney donation. RECENT FINDINGS The growing rate of obesity and associated metabolic syndrome make many potential donors unacceptable as donor candidates because of the future risk for developing chronic health conditions, such as hypertension and diabetes. There is also increasing evidence demonstrating socioeconomic differences and racial disparities potentially limit access to living donation in certain populations. These potentially modifiable factors are not exclusive of each other and together serve as significant contributing factors to lower rates of living donation. SUMMARY Living donors make sacrifices to provide the gift of life to transplant recipients, despite the potential risks to their own health. Studies describing risk factors to living donation call attention to the overall need for more action to prioritize and promote the health and well being of living donors.
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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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Martin WP, White J, López-Hernández FJ, Docherty NG, le Roux CW. Metabolic Surgery to Treat Obesity in Diabetic Kidney Disease, Chronic Kidney Disease, and End-Stage Kidney Disease; What Are the Unanswered Questions? Front Endocrinol (Lausanne) 2020; 11:289. [PMID: 33013677 PMCID: PMC7462008 DOI: 10.3389/fendo.2020.00289] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 04/17/2020] [Indexed: 12/11/2022] Open
Abstract
Obesity is a major factor in contemporary clinical practice in nephrology. Obesity accelerates the progression of both diabetic and non-diabetic chronic kidney disease and, in renal transplantation, both recipient and donor obesity increase the risk of allograft complications. Obesity is thus a major driver of renal disease progression and a barrier to deceased and living donor kidney transplantation. Large observational studies have highlighted that metabolic surgery reduces the incidence of albuminuria, slows chronic kidney disease progression, and reduces the incidence of end-stage kidney disease over extended follow-up in people with and without type 2 diabetes. The surgical treatment of obesity and its metabolic sequelae has therefore the potential to improve management of diabetic and non-diabetic chronic kidney disease and aid in the slowing of renal decline toward end-stage kidney disease. In the context of patients with end-stage kidney disease, although complications of metabolic surgery are higher, absolute event rates are low and it remains a safe intervention in this population. Pre-transplant metabolic surgery increases access to kidney transplantation in people with obesity and end-stage kidney disease. Metabolic surgery also improves management of metabolic complications post-kidney transplantation, including new-onset diabetes. Procedure selection may be critical to mitigate the risks of oxalate nephropathy and disruption to immunosuppressant pharmacokinetics. Metabolic surgery may also have a role in the treatment of donor obesity, which could increase the living kidney donor pool with potential downstream impact on kidney paired exchange programmes. The present paper provides a comprehensive coverage of the literature concerning renal outcomes in clinical studies of metabolic surgery and integrates findings from relevant mechanistic pre-clinical studies. In so doing the key unanswered questions for the field are brought to the fore for discussion.
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Affiliation(s)
- William P. Martin
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- *Correspondence: William P. Martin
| | - James White
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Francisco J. López-Hernández
- Instituto de Estudios de Ciencias de la Salud de Castilla y León-Instituto de Investigación Biomédica de Salamanca (IECSCYL-IBSAL), Hospital Virgen Vega, Salamanca, Spain
| | - Neil G. Docherty
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
| | - Carel W. le Roux
- Diabetes Complications Research Centre, School of Medicine, Conway Institute of Biomolecular and Biomedical Research, University College Dublin, Dublin, Ireland
- Division of Investigative Science, Imperial College London, London, United Kingdom
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Takagi K, Kimenai HJAN, IJzermans JNM, Minnee RC. Obese living kidney donors: a comparison of hand-assisted retroperitoneoscopic versus laparoscopic living donor nephrectomy. Surg Endosc 2019; 34:4901-4908. [PMID: 31741163 PMCID: PMC7572329 DOI: 10.1007/s00464-019-07276-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Accepted: 11/12/2019] [Indexed: 12/20/2022]
Abstract
Background The aim of this study was to examine the difference in outcome between hand-assisted retroperitoneoscopic and laparoscopic living donor nephrectomy in obese donors, and the impact of donor body mass index on outcome. Methods Out of 1108 living donors who underwent hand-assisted retroperitoneoscopic or laparoscopic donor nephrectomy between 2010 and 2018, 205 were identified having body mass index ≥ 30. These donors were included in this retrospective study, analyzing postoperative outcomes and remnant renal function. Results Out of 205 donors, 137 (66.8%) underwent hand-assisted retroperitoneoscopic donor nephrectomy and 68 donors (33.2%) underwent laparoscopic donor nephrectomy. Postoperative outcome did not show any significant differences between the hand-assisted retroperitoneoscopic donor nephrectomy group and the laparoscopic donor nephrectomy group in terms of major complications (2.2% vs. 1.5%, P = 0.72), postoperative pain scale (4 vs. 4, P = 0.67), and the length of stay (3 days vs. 3 days, P = 0.075). The results of kidney function in donors after nephrectomy demonstrated no significant differences between the groups. Additional analysis of 29 donors with body mass index ≥ 35 (14.1%) as compared with 176 donors with body mass index 30–35 (85.9%) revealed no significant differences between groups in postoperative outcomes as well as kidney function after donation. Conclusion Our results show that laparoscopic living donor nephrectomy for obese donors is safe and feasible with good postoperative outcomes. There were no significant differences regarding postoperative outcome between hand-assisted retroperitoneoscopic and laparoscopic donor nephrectomy. Furthermore, the outcome in donors with body mass index ≥ 35 was comparable to donors with body mass index 30–35.
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Affiliation(s)
- Kosei Takagi
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands. .,Department of Gastroenterological Surgery, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan.
| | - Hendrikus J A N Kimenai
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
| | - Robert C Minnee
- Division of HPB & Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Centre Rotterdam, Dr. Molewaterplein 40, 3015 GD, Rotterdam, The Netherlands
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25
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Waits SA, Englesbe MJ. Invited Commentary: Concurrent nephrectomy and bariatric surgery for obese living kidney donors. Surgery 2019; 166:209-210. [PMID: 30929898 DOI: 10.1016/j.surg.2019.02.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 02/12/2019] [Indexed: 11/27/2022]
Affiliation(s)
- Seth A Waits
- University of Michigan, Section of Transplant Surgery, Ann Arbor, MI
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