Feasible kidney donation with living marginal donors, including diabetes mellitus
Related Experiment Video
Updated: Nov 2, 2025
A Method for Murine Islet Isolation and Subcapsular Kidney Transplantation
Published on: April 13, 2011
Kasumi Yoshinaga1, Motoo Araki1, Koichiro Wada1
1Department of Urology, Graduate School of Medicine, Dentistry and Pharmaceutical Science, Okayama University, Okayama, Japan.
Objectives:
To compare the donor outcomes of living donor kidney transplantation between standard donors (SDs) and marginal donors (MDs) including diabetic patients (MD + DM).
Methods:
MDs were defined according to Japanese guideline criteria: (a) age >70-years, (b) blood pressure ≤130/80 mmHg on hypertension medicine, (c) body mass index >25 to ≤32 kg/m2 , (d) 24-h creatinine clearance ≥70 to <80 ml/min/1.73 m2 , and (e) hemoglobin A1c > 6.2 or ≤6.5 with oral diabetic medicine. Fifty-three of 114 donors were MDs. We compared donor kidney functions until 60 months postoperatively.
Results:
No kidney function parameters were different between SDs and MDs. When comparing SD and MD + DM, MD + DM had a lower postoperative eGFR (48 vs. 41 (1 (month), p = .02), 49 vs. 40 (12, p < .01), 48 vs. 42 (24, p = .04), 47 vs. 38 (36, p = .01)) and the percentage of residual eGFR (SD vs. MD + DM: 63 vs. 57 (1 (month), p < .01), 63 vs. 57 (2, p < .01), 64 vs. 56 (12, p < .01), 63 vs. 57 (24, p < .01), 63 vs. 52 (36, p = .02)). However, when MD with a single risk factor of DM was compared to SD, the difference disappeared. Nine out of 12 (75%) MD + DM had ≥2 risk factors.
Conclusions:
Although long-term observation of donor kidney function is necessary, careful MD + DM selection had the potential to expand the donor pool.
Insights
Marginal donors (MDs) showed similar kidney function to standard donors (SDs). However, diabetic MDs (MD+DM) with multiple risk factors experienced lower postoperative eGFR, suggesting careful selection is key for expanding the donor pool.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Living donor kidney transplantation is crucial for managing end-stage renal disease.
- Identifying suitable donors, including those with risk factors, can expand the donor pool.
- Marginal donors (MDs) may offer a viable option, but their long-term outcomes require careful evaluation.
Purpose of the Study:
- To compare the short-term and long-term donor kidney function outcomes between standard donors (SDs) and marginal donors (MDs).
- To specifically assess outcomes for MDs with diabetes mellitus (MD+DM) compared to SDs.
- To determine the impact of multiple risk factors in MDs on donor kidney function.
Main Methods:
- Donors were classified as SDs or MDs based on Japanese guidelines, including age, blood pressure, BMI, creatinine clearance, and HbA1c.
- Donor kidney function was monitored up to 60 months post-transplantation.
- Statistical comparisons were made between SDs and MDs, and specifically between SDs and MD+DM groups.
Main Results:
- No significant differences in kidney function parameters were observed between SDs and all MDs.
- MD+DM recipients showed significantly lower postoperative estimated glomerular filtration rate (eGFR) and a lower percentage of residual eGFR compared to SDs.
- The decline in eGFR for MD+DM was more pronounced when donors had two or more risk factors, particularly diabetes.
Conclusions:
- While marginal donors without significant comorbidities demonstrate comparable outcomes to standard donors, careful selection of diabetic marginal donors is essential.
- MDs with multiple risk factors, especially diabetes, may experience reduced long-term kidney function.
- Careful selection protocols for marginal donors, particularly those with diabetes, hold the potential to safely expand the living donor kidney transplantation pool.
Related Concept Videos
01:28Kidney Transplant I: Introduction
01:26Kidney Transplant II: Surgical Procedure
01:16Kidney Transplant III: Nursing Management