Gadelkareem RA, Abdelgawad AM, Mohammed N, Reda A, Azoz NM, Zarzour MA, Hammouda HM, Khalil M. Reasons and effects of the decline of willing related potential living kidney donors. World J Transplant 2023; 13(5): 276-289 [PMID: 37746040 DOI: 10.5500/wjt.v13.i5.276]
Corresponding Author of This Article
Rabea Ahmed Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt. dr.rabeagad@yahoo.com
Research Domain of This Article
Transplantation
Article-Type of This Article
Retrospective Cohort Study
Open-Access Policy of This Article
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World J Transplant. Sep 18, 2023; 13(5): 276-289 Published online Sep 18, 2023. doi: 10.5500/wjt.v13.i5.276
Table 1 Definitions of terms used to describe the living donors at different stages of kidney donation including access, counseling, evaluation, acceptance, candidacy, and donation with kidney transplantation of related intended patients
Term
Definition
PLD
An individual who confirmed his willingness to donate a kidney to an intended patient at the initial counseling settings and was ready to start the evaluation for kidney donation, regardless of the commencement of the evaluation
Related PLD
PLD who had a relative intended patient with end-stage renal disease up to the 4th degree of genetic relatedness. Regardless of their genetic relatedness, the wife or husband of a recipient was considered a related PLD
Excluded PLD
PLD who was disqualified as a kidney donor and excluded from the process of kidney donation by KT team due to causes that disqualify candidacy to donate a kidney, such as medical, immunological, or financial causes
Regressed PLD
PLD who withdrew his decision of kidney donation at any stage after an initial confirmation of the donation decision and before the operation
PLD who was still willing and completed or was still continuing the evaluation, but the related intended patient was withdrawn from KT preparation due to any cause
Candidate PLD
PLD who completed all the steps of evaluation and was finally accepted by the KT team for kidney donation, regardless of the later regression or release from donation
Accepted PLD
PLD who completed the evaluation without exclusion from kidney donation and was accepted for donation without release or regression from his willingness
LD
PLD becomes a LD when he succeeds in donating a kidney to his/her intended patient, which also means KT was achieved
First degree: father, mother, son, daughter, wife, and husband. Second degree: brother, sister, grandfather, grandmother, grandson, and granddaughter. Third degree: nephew, uncle and aunt. Fourth degree: cousins
Table 2 Demographic and clinical characteristics of patients and related potential living donors presented as total patients (n = 212) and as a comparison between patients with candidate (n = 74) and patients with non-candidate (n = 138) potential living donors
Characteristics
Total patients, n = 212
Patients with candidate PLDs, n = 74
Patients with non-candidate PLDs, n = 138
P value
mean ± SD (range)/number (%)
Mean age in yr
31.2 ± 10.6 (13-66)
29.1 ± 9.6 (13-57)
32.9 ± 12.0 (14-66)
0.041
Sex, n = 212
Males
173 (81.6%)
67 (90.5%)
106 (76.8%)
0.087
Females
39 (18.4%)
7 (9.5%)
32 (23.2%)
Status of dialysis at presentation, n = 212
Preemptive
19 (9.0%)
5 (6.8%)
14 (10.1%)
0.462
On regular hemodialysis
193 (91.0%)
69 (93.2%)
124 (89.9%)
Primary kidney disease, n = 212
Unknown
167 (78.8%)
56 (75.7%)
111 (80.4%)
0.088
Systemic disease
14 (6.6%)
3 (2.7%)
11 (8.0%)
Glomerulonephritis
6 (2.8%)
3 (4.0%)
3 (2.2%)
Hereditary renal disease
5 (3.8%)
2 (2.7%)
3 (2.2%)
Obstructive uropathy
11 (5.2%)
8 (10.8%)
3 (2.2%)
Urolithiasis
9 (4.2%)
2 (2.7%)
7 (5.1%)
Categories of primary kidney disease, n = 212
Unknown
167 (78.8%)
56 (75.7%)
111 (80.4%)
0.154
Systemic disease
14 (6.6%)
3 (4.0%)
11 (8.0%)
Local, renal/urinary
31 (14.6%)
15 (20.3%)
16 (11.6%)
Patients per number of PLDs, n = 212
Patients with one PLD
165 (77.8%)
53 (71.6%)
112 (81.2%)
0.265
Patients with two PLDs
39 (18.4%)
17 (23.0%)
22 (15.9%)
Patients with three PLDs
8 (3.8%)
4 (5.4%)
4 (2.9%)
Table 3 Patient characteristics distributed per extent and outcome of evaluation of their potential living donors presented as total patients (n = 212) and as a comparison between patients with candidate (n = 74) and patients with non-candidate (n = 138) potential living donors.
Characteristics
Total patients, n = 212
Patients with candidate PLDs, n = 74
Patients with non-candidate PLDs, n = 138
P value
mean ± SD (range)/number (%)
Patients per extent of evaluation of their PLDs1, n = 212
Table 4 Patients distributed per characteristics of exclusion of their potential living donors presented as total patients (n = 212) and as a comparison between patients with candidate (n = 74) and patients with non-candidate (n = 138) potential living donors.
Characteristics
Total patients, n = 212
Patients with candidate PLDs, n = 74
Patients with non-candidate PLDs, n = 138
P value
mean ± SD (range)/number (%)
Patients per number of excluded PLDs, n = 121
Patients with one excluded PLD
100 (82.6%)
10 (71.4%)
90 (84.1%)
0.764
Patients with two excluded PLDs
19 (15.7%)
4 (28.6%)
15 (14.0%)
Patients with three excluded PLDs
2 (1.7%)
0 (0%)
2 (1.9%)
Patients per causes of exclusion of their PLDs, n = 1211
Combined immunological and medical causes
14 (11.6%)
3 (21.4%)
11 (10.3%)
0.680
HLA-incompatibility
24 (19.8%)
3 (21.4%)
21 (19.6%)
ABO-incompatibility
20 (16.5%)
1 (7.1%)
19 (17.8%)
ABO and HLA-incompatibility
2 (1.7%)
0 (0%)
2 (1.9%)
Age
8 (6.6%)
0 (0%)
8 (7.5%)
Diabetes mellitus
4 (3.3%)
0 (0%)
4 (3.7%)
HCV positive
5 (4.1%)
2 (14.3%)
3 (2.8%)
Hypertension
11 (9.1%)
4 (28.6%)
7 (6.5%)
Leprosy
1 (0.8%)
0 (0%)
1 (0.9%)
Low GFR
4 (3.3%)
1 (7.1%)
3 (2.8%)
High potential recurrence of primary kidney disease
6 (5.0%)
0 (0%)
6 (5.6%)
Proteinuria
12 (9.9%)
0 (0%)
12 (11.2%)
Psoriasis
1 (0.8%)
0 (0%)
1 (0.9%)
Rheumatoid arthritis
1 (0.8%)
0 (0%)
1 (0.9%)
Urolithiasis
5 (4.1%)
0 (0%)
5 (4.7%)
Financial causes
3 (2.5%)
0 (0%)
3 (2.8%)
Patients per main category of causes of exclusion of their PLDs, n = 121
Combined immunological and medical causes
14 (11.6%)
3 (21.4%)
11 (10.3%)
0.866
Immunologic mismatches
46 (38%)
4 (28.6%)
42 (39.3%)
Medical causes
58 (47.9%)
7 (50.0%)
51 (47.7%)
Financial causes
3 (2.5%)
0 (0%)
3 (2.8%)
Patients per timing of PLDs regression, n = 18
During evaluation
13 (72.2%)
0 (0%)
13 (100.0%)
NA
After evaluation
5 (27.8%)
5 (100.0%)
0 (0%)
Patients per cause of release of PLDs, n = 37
Patient death
4 (10.8%)
3 (27.3%)
1 (3.9%)
0.186
Patient regression
22 (59.5%)
6 (54.5%)
16 (61.5%)
Patient non-candidacy
11 (29.7%)
2 (18.2%)
9 (34.6%)
Patients per timing of release of PLDs, n = 37
During evaluation
26 (70.3%)
0 (0%)
26 (100.0%)
NA
After evaluation
11 (29.7%)
11 (100.0%)
0 (0%)
Fate of patients with evaluated PLDs, n = 212
Transplantation in our center
58 (27.4%)
58 (78.4%)
0 (0%)
NA
Transplantation in another center
14 (6.6%)
1 (1.4%)
13 (9.4%)
0.024
On hemodialysis
122 (57.6%)
12 (16.2%)
110 (79.7%)
< 0.001
Death
9 (4.2%)
3 (4.1%)
6 (4.4%)
0.920
Unknown
9 (4.2%)
0 (0%)
9 (6.5%)
0.024
Table 5 Characteristics of potential living donors presented as total (n = 257) and as a comparison between the candidate (n = 74) and non-candidate (n = 183) groups of donors
Table 6 Multivariate logistic regression of the potential variables influencing the candidacy of potential living donors with a completed preparation
Variables
Modality
Odds ratio
P value
Dialysis status
Preemptive vs on dialysis
0.66 (0.23-1.94)
0.451
Number of potential donors
Single vs multiple
1.69 (0.87-3.28)
0.123
Donor age
Increasing age
1.0 (0.97-1.03)
0.925
Donor sex
Men vs women
1.02 (0.55-1.92)
0.940
Relatedness degree
First vs more than first
1.07 (0.55-2.1)
0.834
Citation: Gadelkareem RA, Abdelgawad AM, Mohammed N, Reda A, Azoz NM, Zarzour MA, Hammouda HM, Khalil M. Reasons and effects of the decline of willing related potential living kidney donors. World J Transplant 2023; 13(5): 276-289