Fibromuscular dysplasia and living kidney donors: a narrative review

To address the shortage of grafts, renal transplant teams actively utilize all available donation options, including those that challenge the conventional criteria for living donors. However, this approach may involve situations requiring careful assessment of specific risks-particularly those that could jeopardize donor safety, expose the recipient or graft to vascular complications associated with certain arterial reconstructions, or threaten graft function in the recipient. Kidney donation in the context of fibromuscular dysplasia represents one such scenario, as this condition encompasses all three of these risks. Transplant centers that do not automatically exclude such donations recommend a selective approach, with decisions to accept these kidneys made on a case-by-case basis through evaluation by multidisciplinary teams comprising nephrologists, angiologists, and transplant surgeons. This narrative review aims to provide an update on (1) the identification and assessment of this arterial lesion during predonation evaluation, (2) the acceptability criteria for kidneys affected by fibromuscular dysplasia, (3) the safety and long-term outcomes for donors following nephrectomy, and (4) technical considerations for transplanting these grafts and their outcomes in recipients.