MO945: Disqualification of Donor and Recipient Candidates from The Living Kidney Donation Program: A German Single-Center Analysis

Abstract

Abstract BACKGROUND AND AIMS Kidney transplantation is the best treatment option for patients with end stage kidney disease (ESKD) with a superiority of transplantation after living kidney donation (LKD) compared to deceased donation. However, a large part of potential donors and recipients are ineligible for LKD. Here, we analyze the leading causes for disqualification of prospective living donor-recipient pairs from the LKD program and the health-related consequences for ESKD patients excluded from the LKD program in a German tertiary transplant center. METHOD In this single-center retrospective cohort study we evaluated all candidates (potential donors and recipients) presenting for assessment of LKD from 2012 to 2020 at our transplant center. Thereby we focused on candidates excluded from the LKD program. Main reasons for disqualification were categorized as medical (donor-related), psychosocial, immunological, recipient-related and unknown. RESULTS Overall, 601 donor-recipient pairs referred to our transplant center for LKD assessment during the observation time. Out of those, 326 (54.2%) discontinued the program with 52 (8.7%) dropouts and 274 (45.6%) donor-recipient pairs being ineligible for LKD. Donor-related medical contraindications were the main reason for disqualification (139 out of 274 (50.7%) potential donors) followed by recipient-related contraindications (62 out of 274 (22.6%) of potential donor-recipient pairs). Only 77 out of 257 (29.9%) potential recipients excluded from the LKD program received a kidney transplant afterwards with a median waiting time of 2 (IQR: 1.0–4.0) years. Overall, 18 (7.0%) ESKD patients initially declined for LKD died in this period. CONCLUSION A large percentage of donor-recipient pairs disqualified from the German LKD program, mostly due to medical reasons related to the donor and with partly severe consequences for the potential recipients. For these, we need alternative concepts to make transplantation possible.