BACKGROUND: The presence of kidney stones has been a relative contraindication for living donation. The long term outcomes and safety of kidney transplant recipients of donor gifted lithiasis is not well known. We assess the outcomes of the kidney transplant recipients who received a living donor kidney with a stone in situ.

METHODS: Living donors undergoing nephrectomy between 2003 and 2013 who had nephrolithiasis on preoperative computed tomography (CT) imaging or a history of stone passage were identified. A retrospective chart review with documented donor and recipient demographics, donor 24-hour urine collections, stone size and location, stone events after transplant, and graft function.

RESULTS: Thirty seven donor-recipient were identified and reviewed. Twenty-three (62.1%) patients had valid preoperative 24-hour urine collection, 5 (22%) of whom had hypercalciuria,6 (26%) had hyperoxaluria, 2(9%) had hypocitriuria and only 1 donor had more than 1 metabolic abnormality. Mean 24-hr calcium, oxalate and citrate were 159±73mg, 31.5±8mg and 809±239 respectively.Two (5%) donors had previous symptomatic nephrolithiasis.The mean age of donors was 41±9; 70% females, median 1 stone transplanted, with a mean stone size of 2.5 mm (range 1-6 mm). 24% had more than 1 stone in the donated kidney, while only one donor had bilateral stones. Right side donor nephrectomy was performed in 16(43%) of these donors. Mean age of recipients was 46±18 ; 46% females, with a median follow-up of 44.4 months (IQR 33.1-72.1), with 62% of recipients having a follow-up of more than 3 years. Two donors with nephrolithiasis on preoperative imaging who donated have evidence of nephrolithiasis (one on imaging and passing a stone).

Eighteen recipients have had an imaging of the transplant kidney (US=9, CT=9) at a median follow up of 42.6 months. Two recipients have evidence of nephrolithiasis during the follow-up period (one at bladder stitch site and one on imaging).

CONCLUSION:Accepting allografts with small stones in donors with normal or mild metabolic abnormalities may be acceptable, and careful follow-up in recipients of such allografts is warranted as recurrence in recipients appear to be a low risk complication in donor gifted lithiasis. More long term studies are needed to ensure long term outcomes in donors and recipients. Renal donors and recipients should be educated regarding their unique risks until more long term data is available.

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