Pros and cons of live kidney donation in prediabetics: A critical review and way forward

Abstract

There is shortage of organs, including kidneys, worldwide. Along with deceased kidney transplantation, there is a significant rise in live kidney donation. The prevalence of prediabetes (PD), including impaired fasting glucose and impaired glucose tolerance, is on the rise across the globe. Transplant teams frequently come across prediabetic kidney donors for evaluation. Prediabetics are at risk of diabetes, chronic kidney disease, cardiovascular events, stroke, neuropathy, retinopathy, dementia, depression and nonalcoholic liver disease along with increased risk of all-cause mortality. Unfortunately, most of the studies done in prediabetic kidney donors are retrospective in nature and have a short follow up period. There is lack of prospective long-term studies to know about the real risk of complications after donation. Furthermore, there are variations in recommendations from various guidelines across the globe for donations in prediabetics, leading to more confusion among clinicians. This increases the responsibility of transplant teams to take appropriate decisions in the best interest of both donors and recipients. This review focuses on pathophysiological changes of PD in kidneys, potential complications of PD, other risk factors for development of type 2 diabetes, a review of guidelines for kidney donation, the potential role of diabetes risk score and calculator in kidney donors and the way forward for the evaluation and selection of prediabetic kidney donors.

Keywords: Live kidney donation; Prediabetes; Impaired fasting glucose; Impaired glucose tolerance; Review

Core Tip: An increasing number of prediabetic kidney donors are encountered by transplant physicians. The decision to allow or to not allow these donors is always challenging. Prediabetics are prone to multiple complications in the future, including diabetes mellitus and chronic kidney disease. Variability in recommendations by various organizations and societies about kidney donation in prediabetics leads to even further confusion in decision making. This extensive review focuses on evidence from both the general population and kidney donors regarding kidney donation in prediabetics. This review will help clinicians to take well informed decisions and to identify a direction for further research and the need for a uniform position by international transplant societies like The Transplantation Society or International Society of Nephrology.