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Updated: Nov 2, 2025
A Method for Murine Islet Isolation and Subcapsular Kidney Transplantation
Published on: April 13, 2011
Feasible kidney donation with living marginal donors, including diabetes mellitus
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.
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01:26Kidney Transplant II: Surgical Procedure
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