BACKGROUND: Nephrolithiasis is considered at least a relative contraindication to living donor nephrectomy due to the potential for adverse outcomes of recurrence, obstruction and infection. Data on long-term outcomes for recipients of donor-gifted lithiasis is sparse. We present our experience for outcomes in recipients who received a kidney with nephrolithiasis in situ.

METHODS: Living donors with a history of stone passage or evidence of nephrolithiasis on pre operative computerized tomographic (CT) imaging and those who underwent nephrectomy between 2003 and 2016 were identified. Data were obtained on donors and recipients through retrospective review of medical records. Demographic characteristics, and pertinent pre-transplant work up including 24-hr urine collection results are described. Outcomes of graft function and recurrence of calculi were evaluated.

RESULTS: Between 2003 and 2016, 42 donor-recipient pairs were identified. Mean age of donor and recipients was 41±10 and 45±19 years respectively. Donors were predominantly females (71.5%) while a higher number of males (57%) were recipients. A pre operative 24-hour urine collection was available for 28 (66.7%) donors. Hyperoxaluria (6/28) was the most common predisposing factor followed by hypercalciuria and hypocitraturia (5/28 each). Fifty percent of the patients were noted to have an abnormal urinary pH and 3/28 patients had greater than 1 risk factor. Two (4.8%) donors had previous symptomatic nephrolithiasis. The median stone size was 2 mm (range 1-6 mm). More than one calculus was noted in 21.4% of the donated kidneys, while bilateral stones were noted in 1 patient. Left side donor nephrectomy was performed in 24(57%) of the donors. Recipients were followed for median 4.7(IQR 2.5-6.7) years, with 72% of recipients having a follow-up of more than 3 years. Twenty-six recipients have had an imaging of the transplant kidney (US=17, CT=9) at a median follow up of 3.4 (IQR 0.7-4.1) years. Two recipients have evidence of nephrolithiasis (bladder = 1, asymptomatic but imaging evidence=1). None of the recipients had obstructing renal calculi and no infections related to nephrolithiasis were reported.

CONCLUSION: Recipients with donor-gifted lithiasis have a low risk of complications and recurrence in our experience so far. Donors with small calculi and mild metabolic derangements on pre transplant work up should be considered.

CITATION INFORMATION: Doshi S, Yaqub M, Taber T, Mujtaba M, Mishler D, Adebiyi O, Sundaram C, Powelson J, Sharfuddin A. Kidney Transplant Recipient Intermediate and Long Term Outcomes for Living Donor Gifted Lithiasis. Am J Transplant. 2017;17 (suppl 3).

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