Philip A Clayton1, John R Saunders, Stephen P McDonald, Richard D M Allen, Helen Pilmore, Alan Saunder, Neil Boudville, Steven J Chadban. 1. 1 Australia and New Zealand Dialysis and Transplant Registry, Adelaide, Australia. 2 Transplantation Services, Royal Prince Alfred Hospital, Sydney, Australia. 3 Sydney Medical School, University of Sydney, Sydney, Australia. 4 University of Adelaide, Faculty of Health Sciences, Adelaide, Australia. 5 Auckland City Hospital, Department of Renal Medicine, Auckland, New Zealand. 6 Monash Medical Centre, Surgery, Melbourne, Australia. 7 School of Medicine and Pharmacology, University of Western Australia, Australia.
Abstract
BACKGROUND: Recent literature suggests that living kidney donation may be associated with an excess risk of end-stage kidney disease and death. Efforts to maximize access to transplantation may result in acceptance of donors who do not fit within current guidelines, potentially placing them at risk of adverse long-term outcomes. METHODS: We studied the risk profile of Australian and New Zealand living kidney donors using data from the Australia and New Zealand Dialysis and Transplant Living Kidney Donor Registry over 2004 to 2012. We compared their predonation profile against national guidelines for donor acceptance. RESULTS: The analysis included 2,932 donors (mean age 48.8 ± 11.2 years, range 18-81), 58% female and 87% Caucasian. Forty (1%) had measured glomerular filtration rate less than 80 mL/min; 32 (1%) had proteinuria >300 mg/day; 589 (20%) were hypertensive; 495 (18%) obese; 9 (0.3%) were diabetic while a further 55 (2%) had impaired glucose tolerance; and 218 (7%) were current smokers. Overall 767 donors (26%) had at least one relative contraindication to donation and 268 (9%) had at least one absolute contraindication according to national guidelines. CONCLUSIONS: Divergence of current clinical practice from national guidelines has occurred. In the context of recent evidence demonstrating elevated long-term donor risk, rigorous follow-up and reporting of outcomes are now mandated to ensure safety and document any change in risk associated with such a divergence.
BACKGROUND: Recent literature suggests that living kidney donation may be associated with an excess risk of end-stage kidney disease and death. Efforts to maximize access to transplantation may result in acceptance of donors who do not fit within current guidelines, potentially placing them at risk of adverse long-term outcomes. METHODS: We studied the risk profile of Australian and New Zealand living kidney donors using data from the Australia and New Zealand Dialysis and Transplant Living Kidney Donor Registry over 2004 to 2012. We compared their predonation profile against national guidelines for donor acceptance. RESULTS: The analysis included 2,932 donors (mean age 48.8 ± 11.2 years, range 18-81), 58% female and 87% Caucasian. Forty (1%) had measured glomerular filtration rate less than 80 mL/min; 32 (1%) had proteinuria >300 mg/day; 589 (20%) were hypertensive; 495 (18%) obese; 9 (0.3%) were diabetic while a further 55 (2%) had impaired glucose tolerance; and 218 (7%) were current smokers. Overall 767 donors (26%) had at least one relative contraindication to donation and 268 (9%) had at least one absolute contraindication according to national guidelines. CONCLUSIONS: Divergence of current clinical practice from national guidelines has occurred. In the context of recent evidence demonstrating elevated long-term donor risk, rigorous follow-up and reporting of outcomes are now mandated to ensure safety and document any change in risk associated with such a divergence.
Authors: Anjay Rastogi; Stanley Yuan; Farid Arman; Lewis Simon; Kelly Shaffer; Mohammad Kamgar; Niloofar Nobakht; Jonathan S Bromberg; Matthew R Weir Journal: Transplant Direct Date: 2019-09-19
Authors: Nicole L De La Mata; Philip A Clayton; Patrick J Kelly; Stephen McDonald; Steven Chadban; Kevan R Polkinghorne; Angela C Webster Journal: Transplant Direct Date: 2020-02-10