Date: Tuesday, June 4, 2019
Session Name: Concurrent Session: Kidney Living Donor: Selection
Session Time: 4:30pm-6:00pm
Presentation Time: 5:42pm-5:54pm
Location: Ballroom A
*Purpose: There are very limited data on practice patterns for metabolic and cardiovascular testing of living kidney donor candidates. 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). A majority (63.8%; 44/69) consider candidates with hypertension (HTN) well-controlled on one med, and an additional 8.7% (6/69) consider candidates with HTN well-controlled on two meds. If the candidate is non-African American (AA), 32% (16/50) would accept if no LVH and another 30% (15/50) would if no LVH and above a certain age, most common threshold being 50 years. 42% (21/50) routinely exclude all AAs with HTN. ApoL1 genotyping is routinely performed in all AA candidates by 13.0% of programs (9/69), in selected cases by 31.9% (22/69), and never by 55.1% (38/69). Among programs that perform ApoL1 testing, high-risk genotype is an absolute exclusion criterion in half (51.6%; 16/31) and factors into decision making and informed consent in the other half (48.4%; 15/31). Among pre-diabetics, 2-hr OGTT value of ≥ 140 mg/dL is the most commonly used criterion for exclusion (45; 65.2%). 91.3% (63/69) have BMI thresholds, most common being 35 (58.7%) and 32 (11.1%) kg/m2. 65.2% (45/69) exclude a candidate with a strong family history of diabetes in presence of obesity/ pre-diabetes. Increased age (most commonly > 50 years), cardiovascular risk factors (most commonly ≥ 2) and abnormal EKG are common indications for obtaining cardiac stress testing and echo. A quarter to a third of programs exclude based on commonly reported findings of isolated cardiac abnormalities on EKG or echo, such as mild left atrial enlargement, mild tricuspid regurgitation, mild aortic regurgitation, mild aortic stenosis and mild annular calcification; a similar proportion consider these candidates only if > 50 years [Table]. 75% (48/64) routinely exclude candidates with atrial fibrillation; 12.5% (16/64) consider if age > 50 years. 44.9% (31/69) require smoking cessation 4 weeks prior to surgery, including 10.1% (7/69) that require cotinine or nicotine screen, while 47.8% (33/69) do not require cessation.
*Conclusions: There is significant variability in criteria used for selection of donors based on various metabolic parameters. This highlights the importance of further research on long-term outcomes with various comorbidities to guide practice.
To cite this abstract in AMA style:Garg N, Lentine KL, Inker L, Garg AX, Rodrigue J, Segeb D, Mandelbrot DA. Metabolic and Cardiovascular Evaluation in Living Kidney Donors: Survey of US Transplant Centers 2018 [abstract]. Am J Transplant. 2019; 19 (suppl 3). https://atcmeetingabstracts.com/abstract/metabolic-and-cardiovascular-evaluation-in-living-kidney-donors-survey-of-us-transplant-centers-2018/. Accessed November 21, 2019.
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