Date: Tuesday, June 4, 2019
Session Name: Concurrent Session: Kidney Living Donor: Selection
Session Time: 4:30pm-6:00pm
Presentation Time: 5:06pm-5:18pm
Location: Ballroom A
*Purpose: In recent years, a great deal of new data has emerged on outcomes after living donation. We surveyed US transplant centers to assess current practices in the evaluation of donor candidates.
*Methods: The survey was sent by email to program directors by UNOS using REDCap.
*Results: Response rate was 30.4% (69/227). Median number of living donor transplants in 2017 at responding programs was 22 (range 1-162). For GFR assessment, 69.6% (48/69) programs obtain 24-hour CrCl in all candidates, 11.6% (8/69) obtain measured GFR, and 17.4% (12/69) obtain both tests. 7.3% (5/69) routinely obtain cystatin C. 73.9% (51/69) continue to use GFR ≤ 80 ml/min/1.73m2 for exclusion of candidates, with only 21.7% (15/69) utilizing age-based criteria. Regarding proteinuria, 39.1% (27/69) and 24.6% (17/69) reported using protein excretion rate cut-offs of 300 mg/day and 150 mg/day, respectively, while 21.7% (15/69) reported using albumin excretion rate cut-off of 30 mg/day as their most common practice for exclusion. Programs differ significantly on definition of hematuria (3, 5 or 10 rbc/hpf). 47.8% (33/69) require both urologic evaluation and kidney biopsy for persistent isolated hematuria. Nearly half (43.5%; 30/69) routinely exclude those with thin basement membrane disease. For candidates with history of symptomatic stones, the most common practice (49.3%; 34/69) is to accept if there are no current evidence of stones on imaging and the 24-hour urine profile is low risk; 21.7% (15/69) and 8.7% (6/69) require an additional 5- and 10-year symptom free period respectively. Regarding asymptomatic stones with normal urine profile, 94.2% (65/69) would accept a candidate with one small stone in one kidney, and 47.8% (33/69) would accept someone with one small stone in each kidney. In cases of asymptomatic stones with an easily correctible risk factor, 79.7% (55/69) would accept a candidate with one small stone in one kidney and 33.3% (23/69) would accept a candidate with one small stone in each kidney. The tool developed by Grams et al to estimate ESRD risk is used for decision-making routinely by 14.5% (10/69), sometimes by 42.0% (29/69), and never by 43.4% (30/69) programs. 26.1% (18/69) reported routinely using this tool for candidate education. The 2017 KDIGO guideline recommends setting risk threshold for acceptable projected post-donation ESRD risk; 15.9% (11/69), 13.0% (9/69), 14.5% (10/69) and 1.4% (1/69) programs reported determining lifetime risk thresholds of 1%, 3%, 5% and 10% respectively acceptable for donation; 53.6% (37/69) reported not having yet determined a threshold for decision-making.
*Conclusions: This variability in kidney assessment for donor candidates underscores the importance of further research of various pre-donation renal parameters on long-term post-donation outcomes in this population.
To cite this abstract in AMA style:Garg N, Lentine KL, Inker L, Garg AX, Rodrigue J, Segev D, Mandelbrot DA. Kidney Evaluation in Living Kidney Donors: Survey of US Transplant Centers 2018 [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/kidney-evaluation-in-living-kidney-donors-survey-of-us-transplant-centers-2018/. Accessed October 1, 2020.
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