Abstract
ObjectivesTo compare the donor outcomes of living donor kidney transplantation between standard donors (SDs) and marginal donors (MDs) including diabetic patients (MD + DM).MethodsMDs 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.ResultsNo 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.ConclusionsAlthough long‐term observation of donor kidney function is necessary, careful MD + DM selection had the potential to expand the donor pool.
Highlights
Kidney transplantation is the most useful treatment for patients with end‐stage renal disease (ESRD)
The data from our study suggested that donor kidney function did not differ significantly between the standard donor (SD) and marginal donor (MD) groups
We should carefully follow MD + diabetes mellitus (DM) with multiple risk factors since they had a lower kidney function compared with SD
Summary
Kidney transplantation is the most useful treatment for patients with end‐stage renal disease (ESRD). One of the most notable Japanese criteria for kidney transplants is that donors with DM are approved if their blood glucose is well‐controlled without the need for insulin. This exception is not currently permitted in most other countries because the presence of DM in donor is not allowed in the Amsterdam Forum.[4,5] the adequacy of MD with DM (MD + DM) is currently unknown, since the treatment for DM continues to evolve. This study investigated the adequacy of the current selection criteria for MDs based on the Japanese guidelines, including those with DM, and assessed the changes in renal function of donors after donation
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