PDF
ePub
Citation
Print
Abstract
The increasing waiting times for deceased donor kidneys have focused attention on living donors as a useful way to increase the organ supply. However, living donors with potential medical risks for renal transplantation raise medical and ethical questions for donor nephrectomy about conditions such as hypertension, hematuria, obesity, and old age. Data on the long-term risks of conditions are sparse and potential acceptance criteria are under development. Many older donors hope to donate to their offspring, despite the presence of elevated blood pressure. Transplant professionals have internal debates on these situations that require a well-defined scoring system for donating risk. This review summarizes the characteristics and risk of marginal living donors in renal transplantation and discusses strategies for overcoming the current limitation.
References
1). Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999; 341:1725–30.
2). ESRD registry committee, Korean Society of Nephrology. Current renal replacement therapy in Korea [Internet]. Seoul: Korean Society of Nephrology;2009. [cited 2010 Jan 2]. Available from:. http://www.ksn.or.kr/journal/2009/index.html.
3). Park CG, Kim JS, Shin JS, Kim YH, Kim SJ. Current status and future perspectives of xenotransplantation. J Korean Soc Transplant. 2009; 23:203–13. (박 정 규, 김 정 식, 신 준 섭, 김 용 희, 김 상 준. 이 종 장 기 이 식 의 현 황 과 전 망. 대 한이 식 학 회 지 2009;23: 203–13.).
4). Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, et al. Long-term consequences of kidney donation. N Engl J Med. 2009; 360:459–69.
5). Kaneku HK, Terasaki PI. Thirty year trend in kidney trans-plants; UCLA and UNOS Renal Transplant Registry. Clin Transpl. 2006. 1–27.
6). Reese PP, Caplan AL, Kesselheim AS, Bloom RD. Creating a medical, ethical, and legal framework for complex living kidney donors. Clin J Am Soc Nephrol. 2006; 1:1148–53.
7). Steiner R. How should we ethically select living kidney donors when they all are at risk? Am J Transplant. 2005; 5:1172–3.
8). Boudville N, Prasad GV, Knoll G, Muirhead N, Thiessen-Philbrook H, Yang RC, et al. Donor Nephrectomy Outcomes Research (DONOR) Network. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med. 2006; 145:185–96.
9). Klag MJ, Whelton PK, Randall BL, Neaton JD, Brancati FL, Ford CE, et al. Blood pressure and end-stage renal disease in men. N Engl J Med. 1996; 334:13–8.
10). Textor S, Taler S. Expanding criteria for living kidney donors: what are the limits? Transplant Rev. 2008; 22:187–91.
11). Brancati FL, Whelton PK, Randall BL, Neaton JD, Stamler J, Klag MJ. Risk of end-stage renal disease in diabetes mellitus: a prospective cohort study of men screened for MRFIT. Multiple Risk Factor Intervention Trial. JAMA. 1997; 278:2069–74.
12). Hsu CY, McCulloch CE, Darbinian J, Go AS, Iribarren C. Elevated blood pressure and risk of end-stage renal disease in subjects without baseline kidney disease. Arch Intern Med. 2005; 165:923–8.
13). Torres VE, Offord KP, Anderson CF, Velosa JA, Frohnert PP, Donadio JV Jr, et al. Blood pressure determinants in living-related renal allograft donors and their recipients. Kidney Int. 1987; 31:1383–90.
14). Roberts J, Maurer K. Blood pressure levels of persons 6-74 years. United States, 1971–1974. Vital Health Stat. 11:1977; (i-v):1–103.
15). Chobanian AV, Bakris GL, Black HR, Cushman WC, Green LA, Izzo JL Jr, et al. National High Blood Pressure Education Program Coordinating Committee. Seventh report of the Joint National Committee on prevention, detection, evaluation, and treatment of high blood pressure. Hypertension. 2003; 42:1206–52.
16). Textor SC, Taler SJ, Driscoll N, Larson TS, Gloor J, Griffin M, et al. Blood pressure and renal function after kidney donation from hypertensive living donors. Transplantation. 2004; 78:276–82.
17). Delmonico F. Council of the Transplantation Society. A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines. Transplantation. 2005; 79(6 Suppl):S53–66.
18). Tsinalis D, Binet I, Steiger J, Gasser TH, Thiel G. Can “borderline” living kidney donors (BLKD) be used safely for transplantation? Kidney Blood Press Res. 1999; 22:388–89.
19). Gracida C, Espinoza R, Cedillo U, Cancino J. Kidney transplantation with living donors: nine years of followup of 628 living donors. Transplant Proc. 2003; 35:946–7.
20). Vadivel N, Stankovic A, Rennke HG, Singh AK. Accepting prospective kidney donors with asymptomatic urinary abnormalities: are we shooting in the dark? Kidney Int. 2007; 71:173–7.
21). Yoon HE, Kim SH, Kim YK, Roh ES, Chun YJ, Lee HY, et al. Renal biopsy findings of prospective kidney donors and clinical course of renal allografts. J Korean Soc Transplant. 2007; 21:69–74. (윤 혜 은, 김 수 현, 김 용 균, 노 은숙, 전 연 주, 이 희 연, 등. 신 장 공 여 예 정 자 에 서 시 행 한 신 장 조 직 검 사 소 견 과 이 식 신 의 경 과. 대 한 이 식 학 회 지(최 소 연, 이 정 은, 도 연 실, 장 은 희, 김 용 균, 허 우 성, 등. 당 뇨 병과 고 혈 압 이 없 는 성 인 에 서 대 사 증 후 군 과 만 성 신 질 환 의 상관 관 계. 대 한 신 장 학 회 지 2007;26: 420–6.).
29). Heimbach JK, Taler SJ, Prieto M, Cosio FG, Textor SC, Kudva YC, et al. Obesity in living kidney donors: clinical characteristics and outcomes in the era of laparoscopic donor nephrectomy. Am J Transplant. 2005; 5:1057–64.
30). Tavakol MM, Vincenti FG, Assadi H, Frederick MJ, Tomlanovich SJ, Roberts JP, et al. Long-term renal function and cardiovascular disease risk in obese kidney donors. Clin J Am Soc Nephrol. 2009; 4:1230–8.
31). Nyberg SL, Manivel JC, Cook ME, Gillingham KJ, Matas AJ, Najarian JS. Grandparent donors in a living related renal transplant program. Clin Transplant. 1997; 11:349–53.
32). Young A, Storsley L, Garg AX, Treleaven D, Nguan CY, Cuerden MS, et al. Health outcomes for living kidney donors with isolated medical abnormalities: a systematic review. Am J Transplant. 2008; 8:1878–90.
33). Woo YM, Gill JS, Johnson N, Pereira BJ, Hariharan S. The advanced age deceased kidney donor: current outcomes and future opportunities. Kidney Int. 2005; 67.
35). Kumar A, Verma BS, Srivastava A, Bhandari M, Gupta A, Sharma RK. Long-term followup of elderly donors in a live related renal transplant program. J Urol. 2000; 163:1654–8.
36). Toma H, Tanabe K, Tokumoto T, Shimizu T, Shimmura H. Time-dependent risk factors influencing the longterm outcome in living renal allografts: donor age is a crucial risk factor for longterm graft survival more than 5 years after transplantation. Transplantation. 2001; 72:940–7.
37). Matas AJ, Payne WD, Sutherland DE, Humar A, Gruessner RW, Kandaswamy R, et al. 2,500 living donor kidney transplants: a singlecenter experience. Ann Surg. 2001; 234:149–64.
38). Kerr SR, Gillingham KJ, Johnson EM, Matas AJ. Living donors ＞55 years: to use or not to use? Transplantation. 1999; 67:999–1004.
Table 1.
Categories of living-donor risk factors for CKD
Table 2.
Causes of persistent microscopic hematuria
XML Download