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Experience with marginal living related kidney donors: are they becoming routine or are there still any doubts?
Anand Srivastava1, Tapan Sinha, P P Varma
1Department of Urology, Army Hospital (Research & Referral), Delhi, India. annand_srivastava@yahoo.com
Insights
Kidney grafts from marginal donors, including elderly and those with anomalies, show acceptable outcomes. Donor selection criteria should be periodically reviewed to optimize kidney transplant success.
Area of Science:
- Nephrology
- Transplantation Surgery
- Geriatric Medicine
Background:
- Marginal kidney donors, including elderly individuals and those with anomalies, present unique challenges in organ transplantation.
- Evaluating the outcomes of kidney grafts from these donors is crucial for expanding the donor pool.
Purpose of the Study:
- To analyze donor and recipient outcomes following kidney transplantation using marginal donors.
- To assess the safety and efficacy of utilizing elderly and anomalous donors in kidney donation.
Main Methods:
- Retrospective analysis of 81 marginal kidney donors (46 elderly, 39 with anomalies) between July 1996 and July 2004.
- Evaluation of donor and recipient morbidity, graft survival, recipient survival, and rejection episodes.
Main Results:
- Actuarial 1- and 3-year graft survival rates were 95% and 81%, respectively.
- 26% of recipients achieved serum creatinine levels < 1.4 mg/dL.
- Elderly donors (>60 years) and those with anomalies demonstrated acceptable outcomes, with some hypertensive donors requiring medication adjustments.
Conclusions:
- Current criteria for rejecting kidney donors may need periodic review.
- Kidney grafts from elderly donors and those with anomalies yield acceptable results.
- Hypertensive donors require careful assessment, including ambulatory blood pressure monitoring.
Objectives:
To analyze donor and recipient outcome of grafts from marginal kidney donors (ie, elderly or suffering from some anomaly).
Methods:
We had 81 marginal donors from July 1996 to July 2004; 46 were older than 60 years, and 39 had renal or nonrenal anomaly. The donors and recipients were evaluated for morbidity, graft and recipient survival, and the number of rejection episodes.
Results:
The mean (+/- standard deviation) age of elderly donors was 62.2 +/- 3.1 years. Follow-up ranged from 6 months to 50 months (mean 21.15 +/- 0.9 months). Actuarial 1-year and 3-year graft survival rates were 95% and 81%, respectively. Twenty-six percent of recipients maintained serum creatinine levels less than 1.4 mg/dL. The mean age of hypertensive donors was 46.2 years, and blood pressure was controlled with one drug. Serum creatinine levels in the recipients were less than 1.4 mg/dL in 10 and less than 2.5 mg/dL in the rest. Eleven percent of hypertensive donors required an increase in their antihypertensive medication. All donors showed a 15% to 20% increase in their glomerular filtration rate. Donors underwent simultaneous surgery when indicated.
Conclusions:
Criteria to reject donors need to be reviewed periodically. The elderly and donors with other anomalies are consistently showing acceptable results. Hypertensive donors require assessment with awake ambulatory blood pressure monitoring.
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