Living Donor Kidney Research Articles

Correlation Between CT Renal Angiography of Live Kidney Donors and Intraoperative Findings: A Cross-sectional Study.

Introduction A comprehensive understanding of the renal vascular anatomy variations is paramount to a successful kidney transplant. This reduces vascular injury risks and minimizes ischemia duration, optimizing surgical outcomes. The current study aims to assess the accuracy of renal computed tomography angiography (CTA) findings of live renal donors by comparing them with intraoperative findings. Methods This prospective cross-sectional study was conducted between October 2018 and February 2020. It included all healthy donors with two kidneys of normal size, shape, and position who were deemed suitable for nephrectomy. The CTA examinations were performed with the same protocol, which combined the vascular-excretory phase. A specialized radiologist confirmed anatomical findings. The CTA results were compared with intraoperative findings, which were documented by the transplantation team. Results The study included 220 patients. The preoperative CTA was highly sensitive and accurate, reaching 99.5% and 98.6%, respectively, for single vessels and 100% sensitivity and accuracy for triple vessels, pelvicalyceal system, and ureter duplication. The sensitivity of CTA for double vessels (vein and artery) was 90% and 92.6%, respectively, while accuracy was 98.6% for both. Conclusion CTA can be used to assess renal arteries and veins for potential renal donors with high accuracy. Although the CTA's minor, statistically non-significant discordance with the surgical findings regarding double arteries and veins, no artery or vein was missed on the CTA. Therefore, the sensitivity of CTA can reach 100%.

Outcomes of living kidney donors following donor nephrectomy in Aotearoa New Zealand

BackgroundLiving donor kidney transplantation is the optimal treatment for people with kidney failure. Because living donors do not derive health benefits from donation, contemporary relevant information on post-donation outcomes need to inform decision-making. Studies of donor outcomes are largely restricted to donations in the USA and Europe. We studied donors over a 30 years in Aotearoa New Zealand (NZ) to investigate short and long-term outcomes. MethodsThis was a retrospective observational cohort study of all living kidney donors in NZ (1988-2018). The primary outcome was the incidence of kidney failure. Secondary outcomes were death, cardiovascular disease, and the incidence of complications within 90 days after nephrectomy. Donors were identified using multiple data sources: the NZ Blood Service, the Ministry of Health, hospital records, and the Australia and New Zealand Live Kidney Donor Registry. Outcomes were determined via data linkage with Australia and New Zealand Dialysis and Transplant Registry and the Ministry of Health. Follow-up was until 31st December 2019. Results1339 people donated a kidney from 1988-2018. During 16,272 person-years of follow-up, 5 people developed kidney failure, an incidence of 3 per 10,000 person-years (95% CI:1.3-7.4). Patient survival was 99%(98.2-99.5) at 10 years; 30 people died during follow-up. The incidence of cardiovascular disease was 11.6(95% CI:7.4-19.2) per 10,000 person-years. 292 donors(22%) experienced a complication following donor nephrectomy and 69(5%) required intervention. ConclusionsThere is a low risk of kidney failure and other complications among living kidney donors in NZ. These findings represent important contemporary data to support decision making.

Attitudes Toward Use of an APOL1 Genetic Testing Chatbot in Living Kidney Donor Evaluation: A Focus Group Study.

Living kidney donor (LKD) candidates of African ancestry are increasingly asked to undergo Apolipoprotein L1 (APOL1) genetic testing during the donor evaluation process to better understand their risk of kidney disease. LKD candidates' attitudes about using a clinical chatbot on APOL1 remain unknown. This study builds on prior work to culturally adapt the Gia (Genetic Information Assistant) chatbot on APOL1 by assessing donor, recipient, and community member attitudes about the Gia chatbot for enhancing the integration of APOL1 testing into the LKD clinical evaluation workflow. This study involved focus groups and a post-focus group survey in two US cities about the APOL1 Gia chatbot. Qualitative data were analyzed via thematic analysis, and descriptive statistics were used for demographic data. We conducted 10 focus groups including 54 participants (25 LKDs, 23 community members, and 6 living donor kidney transplant recipients of African ancestry). Five themes emerged: (1) participants supported LKD candidates using the Gia chatbot before the nephrologist clinic visit, (2) participants were interested in undergoing APOL1 testing after using Gia, (3) APOL1 testing costs may influence LKD candidates' willingness to get tested, (4) patients of African ancestry may hold varying preferences for using chatbots in the healthcare setting, and (5) individual-level barriers may limit the use of Gia in the healthcare setting. Individuals of African ancestry were highly receptive to integrating the APOL1 chatbot into LKD candidate clinical evaluation, which bodes well for integrating chatbots into the APOL1 clinical genetic testing process.

Brief Report: Unmet Need for Solid Organ Transplantation Among People With HIV and End-Stage Kidney or Liver Disease: A Brief Report From the HIV Outpatient Study, 2009–2023

Background: Persons with HIV (PWH) with end-stage kidney disease (ESKD) who are eligible for kidney transplantation have post-transplantation outcomes similar to those without HIV infection. However, barriers to referral for care, evaluation, and receipt of transplants remain for PWH. We sought to identify PWH with ESKD or end-stage liver disease (ESLD) who would be candidates for organ transplant and to review their clinical outcomes. Methods: We analyzed data from participants in the HIV Outpatient Study (HOPS) between January 1, 2009, and June 30, 2023, with a diagnosis of ESKD or ESLD. We identified a subset of PWH who would otherwise meet the general criteria for kidney or liver transplantation. Targeted clinical outcomes included dialysis, transplantation, and death. Results: Among 5215 PWH in the HOPS, 258 with ESKD and 23 with ESLD would otherwise meet the criteria for transplant. However, only 9 kidney and 2 liver transplants were performed. Conclusions: Low transplantation rates among eligible PWH suggest that timely referral for care and evaluation for kidney and liver transplantation often does not occur. Expanding access for PWH with ESKD to both deceased and living donor kidney allografts is needed. Kidney and liver transplant centers also need to seek ways to broaden access for eligible PWH with ESKD or ESLD.

Successful Vascular Graft Reconstruction of Short Renal Artery Using Polytetrafluoroethylene (PTFE) in Living Donor Kidney Transplantation—A Case Report and Review of Literature

Short donor renal artery during nephrectomy poses a technical challenge. We present a main renal artery (RA) reconstruction case in Living-donor kidney transplantation (LDKT) using an extension polytetrafluoroethylene vascular graft(PTFE). A 57-year-old man received LDKT from his son. Post-laparoscopic donor nephrectomy, a PTFE graft was used to reconstruct the short RA. Excellent reperfusion, good renal turgor, and immediate urine production were noted. Serial Doppler assessments on postoperative days 1, 3, and 7 and 180 confirmed good blood flow. The PTFE graft did not cause any additional morbidity or complications related to kidney transplantation.

Assessing Pharmacokinetics and Safety of Therapeutic Alpha-1-Microglobulin in First-in-Human Kidney Transplantation: A Noncomparative Open-Label Multiple-Dose Phase 1b Study.

RMC-035 is a modified version of alpha-1-microglobulin, an endogenous protein developed as a renoprotective agent. Its intended use is to reduce the risk of irreversible loss of kidney function in cardiac surgery patients and to reduce delayed graft function in kidney transplant recipients. This first-in-human study aimed to evaluate the pharmacokinetics and safety of RMC-035 in kidney transplant recipients. Eight living-donor kidney transplant recipients were included in 2 dose cohorts. The study drug RMC-035 was administered starting with the first dose during transplantation. Four additional doses were administered once daily following transplantation. In the first cohort, all 5 doses of RMC-035 were equal, whereas in the second cohort, the last 3 doses were doubled. Safety monitoring, laboratory tests, and pharmacokinetic measurements were performed according to protocol for 4 d post-transplantation and during the 90-d follow-up period. All 5 administrations of the study drug were completed in 5 out of 8 treated participants. Pharmacokinetic concentrations were approximately dose proportional, and AUC0-24h decreased between the first and fifth doses, reflecting improved kidney function and RMC-035 renal clearance over time. No accumulation was observed between the administrations. No clinically significant changes were observed in the hematological or biochemical laboratory parameters, electrocardiogram findings, or vital signs. A total of 22 treatment-emergent adverse events (AEs) were reported in 6 subjects. Mild and transient AEs suggestive of infusion-related reactions, such as chills, were reported in 5 patients. There was a clinically significant reduction in serum creatinine levels, reflecting post-transplant improvement in kidney function. Based on the safety data obtained from 8 subjects in the 2 dose cohorts treated with RMC-035, the drug was considered safe. Safety and AE profiles were in line with expectations of the target population, and infusion-related reactions were short-lived and manageable. Dose-limiting toxicity signals were not observed.

Analyzing body composition in living kidney donors: impact on post-transplant kidney function

Living donor kidney transplantation boasts superior patient and graft survival rates compared to deceased donor kidney transplantation. However, the impact of living donor body composition (BC) on post-transplant kidney function remains uncertain. In a cohort of 293 living kidney donor-recipients pairs, we utilized linear mixed model analyses, adjusted for time and including a multiplicative interaction term of time with the donor body composition measure, and found no significant associations between any donor BC measure and the annual change in recipient post-transplantation estimated glomerular filtration rate (eGFR) [donor body mass index (BMI): B=-0.01, 95%CI -0.13; 0.11, p=0.88; donor waist circumference: B=0.02, 95%CI -0.02; 0.06, p=0.38; donor skeletal muscle index: B=-0.02, 95%CI -0.07; 0.04, p=0.63; donor skeletal muscle radiation attenuation: B=-0.002, 95%CI -0.06; 0.06, p=0.96; donor visceral adipose tissue index: B=-0.001, 95%CI -0.02; 0.02, p=0.93; donor subcutaneous adipose tissue index: B=-0.001, 95%CI -0.02; 0.02, p=0.94; donor intramuscular adipose tissue index: B=-0.12, 95%CI -0.29; 0.06, p=0.19; donor total abdominal adipose tissue index: B=-0.001, 95%CI -0.01; 0.01, p=0.89]. Our study suggests that pre-donation BC does not affect post-transplantation recipient eGFR in donor populations with a BMI below 35 kg/m2.

Exploring the relationship between website quality and equity in living donor kidney transplant

BackgroundHealth system websites are important resources to guide health care decisions and may be useful tools to improve racial equity in access to living donor kidney transplant (LDKT).MethodsWe performed a cross-sectional study of adult LDKT programs in the United States. We created an assessment tool for website quality across three domains: accessibility (access to LDKT specific information from the transplant center website), readability (ease of reading and clarity), and educational content (appropriateness and presentation of information, LDKT-specific content, program-specific characteristics, and adherence to equity-centered principles of web design).ResultsAmong the 185 transplant center websites reviewed, only 14.6% of LDKT sites could be accessed directly from the transplant center webpage. The median suitability assessment of materials (SAM)—a validated measure of website content for chronic kidney disease (CKD)—was 45 out of 86 (IQR 4) and the median Flesch-Kincaid grade level and ease score were 9.1 (IQR 0.8) on a scale of 0–18 and 51.2 (IQR 5) on a scale of 0–100, respectively.ConclusionThese results indicate that LDKT websites are currently not available, accessible, and understandable for many potential transplant candidates and donors. Optimizing the content and design of transplant center websites may be a promising and effective strategy for improving equity in access to LDKT.

A qualitative case study of health system barriers and facilitators to living donor kidney transplantation in Canada's most populous province

AbstractPatients with kidney failure need dialysis or a kidney transplant to survive. Living donor kidney transplantation (LDKT) is the best therapeutic option, yet global rates of LDKT have minimally increased, and there are disparities in access. The need for a systems approach to improvement has been highlighted. We aimed to understand what elements of a relatively large health system interact to deliver LDKT and act as facilitators or barriers. This was an exploratory case study of Ontario, the most populous province in Canada that conducts 600–700 kidney transplantations annually, of which ~30% are LDKT. Data collection entailed interviews with multiple stakeholders (n = 37), and document review (n = 29) served as a means of triangulating the data. Data were analyzed using inductive thematic analysis. A multicomponent intervention to facilitate kidney transplantation was simultaneously being conducted which allowed us to capture its impact (EnAKT‐LKD). Eight themes were identified, that were separated into facilitators and barriers. Centralized leadership, directed resource deployment, dynamic communities of practice, and informal collaborations between various elements of the health system were found to facilitate LDKT. Barriers were inadequate donor and patient resources to support equitable access, lengthy and poorly coordinated workups for donors and recipients, and issues of jurisdictional control and competition for resources. The EnAKT‐LKD initiative was described as having boosted resource deployment and collaborative capacity and improved strategic alliances by establishing communities of practice. This case study has identified how individual elements in a health system interact to facilitate and impede the delivery of a therapy to patients.

The Development of a Predictive Model for Postoperative Renal Function in Living Kidney-Transplant Donors

Background/Objectives: The accurate prediction of postoperative renal function (post-RF) in living kidney donors is essential for optimizing donor safety and long-term health. After nephrectomy, renal function can be significantly altered, owing to the functional adaptation of the remaining kidney; however, the extent of this has not been investigated. This study aimed to examine how various donor factors affect functional adaptation after nephrectomy, and to develop a new predictive model. Methods: In total, 310 patients who underwent donor nephrectomy were included. Preoperative split renal function (pre-SRF) of the remaining kidney was measured. Post-RF was measured 1 month after surgery. The functional adaptation rate was calculated from the difference between pre-SRF and post-RF. Multiple regression analysis was performed to develop a predictive formula for post-RF, incorporating donor age and pre-SRF. Results: The median age of the donors was 60 years, and 38.7% were men. The median pre-SRF was 36.4 mL/min/1.73 m2. The median functional adaptation rate was 26.8%, with donor age, pre-SRF, and a history of hyperuricemia (HUA) being significant predictors of the functional adaptation rate. The equation for post-RF was established as 0.94 × pre-SRF − 0.12 × age + 18.87 mL/min/1.73 m2. The estimated post-RF showed a high coefficient of determination (R2 = 0.76), with a mean bias of –0.01 mL/min/1.73 m2. Conclusions: Donor age, pre-SRF, and HUA are key predictors of renal functional adaptation after nephrectomy. The developed formula accurately estimates post-RF, supporting clinical decision-making and donor counseling for living kidney donations.

Health-Related Quality of Life in Living Kidney Donors Participating in Kidney Exchange Programs

Abstract Kidney exchange programs (KEP) have revolutionized living donor kidney transplantation (LDKT) by enabling transplants for patients with HLA or ABO incompatible donors. However, the implications for donors participating in KEP, particularly regarding postoperative health-related quality of life (HRQoL), are not well elucidated. This study compares the HRQoL of donors participating in KEP with donors donating directly (non-KEP). The study included 724 donors, with 121 in the KEP group and 603 in the non-KEP group. Outcomes were assessed using the mental component summary (MCS), physical component summary (PCS), EQ-5D-3L, MVI-20 score, and self-rated pain level. We used a mixed-effects regression model to assess differences between KEP and non-KEP over time, accounting for repeated measures within subjects. There was a significant temporary decline in both the MCS and PCS post-donation; however, these outcomes returned to pre-donation levels after an interval of two month. Donors participating in the KEP had higher PCS and MCS 1-year post-donation. Comparable results were observed in the self-assessed HRQoL using the EQ-5D-3L instrument, as well as in the fatigue scores measured by the MVI-20. We found that participation in KEP does not adversely affect donors' short- or long-term mental and physical HRQoL outcomes and that LDKT donors have HRQoL of pre-donation levels soon after donation. These insights are reassuring, indicating that donors participating in KEP can expect HRQoL comparable to those who do not. This reinforces the viability of KEP as a safe option for expanding LDKT and findings can inform patient and donor education.

Plasma high-sensitivity C-reactive protein measured prior to transplant is related to prediabetes in first-year kidney transplant recipients: A single-center cross-sectional study in Vietnam

AimTo determine the rate of prediabetes among and the pre-transplant plasma high-sensitivity C-reactive protein (hs-CRP) value predictive of prediabetes in patients during their first year post-living donor kidney transplant. MethodsA total of 538 patients underwent living donor kidney transplantation between January 2018 and December 2020, 413 of whom met the inclusion criteria for this study. All patients underwent oral glucose tolerance tests (OGTTs) with 75 g glucose/200 mL solution, starting 3 months post-transplant and repeating the test every 3 months for the first year. Clinical and paraclinical indicators and plasma hs-CRP concentrations were quantified the day prior to the transplant. Prediabetes was diagnosed according to the American Diabetes Association 2018 criteria as a 2-h OGTT result between 140 mg/dL (7.8 mmol/L) and 199 mg/dL (11.0 mmol/L). ResultsThe rate of prediabetes among the study subjects was 38.3 % (158/413). Body mass index (BMI) and pre-transplant plasma triglycerides, high-density lipoprotein cholesterol (HDLC), and hs-CRP levels were related factors predictive of prediabetes in patients within the first year post-kidney transplant based on multivariate logistic regression and receiver operative characteristic curve models. Hs-CRP was the factor with the best predictive value (area under the curve = 0.89; p < 0.001). ConclusionsPre-transplant plasma hs-CRP levels were a good predictor of prediabetes in the first year post-living donor kidney transplant.

Prevalence of left kidney vein entrapment signs on computed tomography angiography images of kidney donors.

The Nutcracker phenomenon (NC-P) is the entrapment of the left kidney vein (LKV) between the superior mesenteric artery and the abdominal portion of the aorta. We aimed to evaluate the frequency of significant left renal vein compression in a healthy population. The computed tomography angiography images of the 131 healty patients who underwent living kidney donor nephrectomy at our institution were enrolled in this retrospective, descriptive anatomic study. Three (2.3%) cases had severe, 26 (19.8) had moderate stenosis. The mean aorto-mesenteric angle was more narrow in females (p< 0.05). The mean LKV diameter ratio and beak angle were shorter and more narrow in females (p< 0.05,p < 0.01; respectively). Thirteen cases (9.9%) showed three or four positive criteria for NC-P. As patients got younger and had BMI < 30 kg/m², the rate of positive criteria determination was increased (p< 0.05,p < 0.01; respectively). The NC-P criteria were seen with a high frequency in healthy individuals. Female and younger individuals with less BMI showed a greater prevalence of positive criteria. Revision of the current standards for NC-P with a distinct classification between sex, age, andBMI is required to assess LKV compression better.

Renal Collecting System Calcified Hematoma Following Parenchymal Perforation by Ureteral Stent in Kidney Transplantation: A Case Report

Introduction: Renal parenchymal perforation by ureteral stent placement is a rare but serious complication. There is also a paucity of data regarding collecting system hematomas and potential calcification in renal allografts. Case presentation: We report a unique case of a 51-year-old male who underwent unrelated living-donor kidney transplantation with stent incorporation during ureteroneocystostomy. Post-operatively he was found to have renal parenchymal perforation by the ureteral stent resulting in a pelvicalyceal hematoma with subsequent calcification and obstruction. At the time of guidewire introduction for percutaneous nephrolithotomy one year later, a nephrostogram and passage of a hydrophilic guidewire resulted in improved contrast drainage into the bladder, so the invasive surgery was no longer needed. Discussion: There are few reported cases of renal parenchymal perforation by a ureteral stent, none of which resulted in a collecting system hematoma. The calcification of urinary tract hematomas is also rare and attributed to metabolic abnormalities, prolonged stagnation of blood, and infection. Conclusions: We suspect the nephrostogram and guidewire introduction created enough antegrade pressure and mechanical disruption to force the calcified hematoma into the bladder.

“A call to action: amplifying the role of men in bridging the gender gap in live kidney donations"- A Letter to the Editor

Dear Editor, We are writing this letter to expound upon an underreported and rarely talked about issue referencing the gender bias invloving the live kidney donations. That being said, the purpose of this letter is purely to underscore the fact that women are less likely to receive a living donor transplant as compared to men. However, they are more likely to serve as living donors for kidney transplantation. [1] Multiple contributory factors including societal stigmas and cultural biases can be attributed to this approach. The evidence of this sex disparity is much more prominent in south Asian countries where men have a 10 times more likely chance to receive a kidney transplant than women. [2] Apart from the male dominance influenced by the socioeconomic reason, this gender imbalance is difficult to quantify. Many women feel obliged to accept the traditional role to care for sick family members. They are less able to refuse the appeal for help within the family compared to men. This is especially true for mothers and spouses. [3] When it comes to men, documented instance in literature show that men in situations where they needed to donate silently disappear from the scene and only show up once the transplantation is over, leaving the women to step forward in this situation. This, cowardice of men is cemented by a recent story of a 36-year-old man with end- stage renal failure. Although one of his healthy brothers was a perfect match, the burden of the transplant still befelled on their old mother. [4] Kidney donation is an act of altruism and devotion. As evidenced by the statistics, the local literature also have frequently portray that women are the frontrunners in this race, while the men are falling far behind. Here the authors need to make it very clear that our purpose is not to say that all men would react this way, but it is to highlight the huge contrast between men and women stepping up as donors for their families. The primary objective of this letter is to accentuate the importance of enhanced access to care for women requiring transplantation while fostering within the male population a deeper understanding of the myths surrounding organ donation and the vital importance of supporting the women in their lives during such critical moments.

Panel-reactive antibodies in kidney transplantation for patients with end-stage renal failure

BACKGROUND: Kidney transplantation is a recognized method of treating patients with end–stage kidney disease. However, the risk of graft loss is not excluded. In Azerbaijan, kidney transplantation is mainly performed from living donors; nevertheless, there is little data on the panel-reactive antibodies (PRA) and its use in the transplantation program. AIM: To evaluate the prevalence of positive panel-reactive antibodies (PRA) and short-term outcomes of living donor kidney transplantation. MATERIALS AND METHODS: Within 6 months after kidney transplantation, 113 recipients were followed up. All patients underwent their first transplantation. Complement-dependent cytotoxicity cross-matching, HLA typing, and flow cytometry cross-matching were carried out. Flow cytometric analysis was applied to detect PRA. The positive response percentage is presented by the percentage of events shifted to the right of the cutoff point. Data were analyzed using SPSS 16.0 statistical software. RESULTS: Among the examined patients, men predominated. In PRA-positive patients (n = 20), the dialysis duration was on average 22.3% longer than in PRA-negative patients (n = 93). 35.0% of PRA-positive patients had class I PRA, 30.0% of patients had class II PRA, and 35.0% had class I + II PRA. In 40.0% of cases, positive PRA had high sensitization 50% (predominantly class II), and the remaining 60.0% had PRA from 10% to 50%. Sensitizing factors were more common in the PRA-positive group (p 0.05). After 6 months of folow-up, the mean creatinine level was 183.4 ± 68.84 nmol/l in the PRA-positive group and 198.15 ± 108.23 nmol/l in the PRA-negative group (p = 0.91). The overall emptying rate was 4.4% (n = 5), with all 5 cases being in the PRA-negative group. No deaths were observed during the follow-up period. CONCLUSIONS: PRA positive patients usually have some sensitizing event such as pregnancy or blood transfusion. The transfusion itself was not a significant factor of sensitization in this study. Patients with high PRA levels require more thorough examination.

Use of polytetrafluoroethylene graft in vascular reconstruction of living donor kidney transplant in a reference center

Use of polytetrafluoroethylene graft in vascular reconstruction of living donor kidney transplant in a reference center

Abstract 4137883: Association of Pre-Donation Blood Pressure with Hypertension in Living Kidney Donors

Background: Living kidney donors (LKD) are at risk for developing hypertension (HTN); however, the levels of pre-donation blood pressure (BP) that may predict post-donation BP are unknown. Hypothesis: Higher pre-donation BP is associated with a greater risk of developing post-donation HTN. Goals: We aim to examine the association between pre-donation BP and the risk of developing HTN in LKD. Methods: A retrospective cohort study using OPTN/SRTR included adult LKD undergoing donation between 6/1972 and 9/2022. Systolic and diastolic hypertension (SHTN and DHTN) were defined by SBP ≥130 and DBP ≥80 mmHg, respectively. Multiple Cox regression was utilized to examine the association between decile of pre-donation BP and time-to-event of developing post-donation SHTN and DHTN. Results: Of 174,311 adult LKD, the mean±SD age was 41±12 years and 60% were female. Mean pre- and post-donation SBP and DBP and deciles of BP are shown in Table 1 and Figure 1, respectively. The median time to follow-up for developing SHTN was 13.2 (IQR 6.8, 24.4) and DHTN was 12.2 months (IQR 6.3, 24.1). The incidence rate of developing SHTN and DHTN was 0.020 and 0.03 person-months, respectively. After adjusting for age (&lt;65 vs. ≥65 y/o), gender, race, U.S. citizenship, education level, history of pre-donation HTN, diabetes, pre-donation BMI, DBP, eGFR, urine protein:creatinine ratio, and the interaction term between decile of pre-donation SBP and age, LKD in deciles 5 to 10 (SBP 119–200 mmHg) had significantly graded increased risk for developing SHTN compared to LKD in decile 4 (SBP 115-118 mmHg; HR decile10 4.82, 95%CI 3.37, 6.91), while those in deciles 1 to 3 had a graded decrease in the risk but were non-significant (HR decile1 0.68, 95CI% 0.42, 1.11). In addition, there was a decreased risk of SHTN observed in elderly LKD (≥65 y/o) in deciles 5 and 10 (P interaction 0.041 and 0.009). The pattern of pre-donation DBP decile – DHTN association was similar to the SBP – SHTN association, but only DBP deciles 8-10 (DBP 81–195 mmHg) were significant (HR decile10 2.10, 95%CI 1.31, 3.34); Figur 2. There was no interaction between pre-donation DBP and age. Conclusions: Elevated pre-donation SBP or DBP greater than 118 or 80 mmHg is associated with a graded increase in developing post-donation SHTN or DHTN, respectively especially in the non-elderly (&lt;65 years old) LKD. BP control during the pre-donation period should be achieved to mitigate the risk of post-donation HTN.

Open donor nephrectomy via singular pararectal extraperitoneal mini-incision: single-center experience with 425 consecutive cases

BackgroundLaparoscopic techniques have been successfully implemented for living kidney donation. However, open surgical procedures also yield excellent perioperative outcomes. Endoscopic donor nephrectomy is associated with minimal trauma but is difficult for right-sided nephrectomies. Here, an open nephrectomy approach using a singular pararectal extraperitoneal mini-incision (SPEM) and the perioperative results are presented to elucidate whether open surgery is still justified in the modern era of endoscopic surgery.MethodsIn this single-center retrospective study, all living kidney donations performed at the Department of General, Visceral and Transplant Surgery of the Hannover Medical School from January 2007 to December 2017 were assessed. Donor characteristics, operation time, transfusion requirements, perioperative complications, and graft outcomes were analyzed.ResultsOut of a total of 1681 kidney transplantations, 425 living kidney donations (25.2%) were performed. Donors were primarily female (273; 64.2%) and had a median age and body-mass index of 53 (24–76) years and 25.3 (16.8–36.4) kg/m2, respectively. The left kidney was harvested in 50.1% (211) of cases. Median operative time was 95 (48–212) min. Intraoperative transfusion was not required in any of the donors. Intraoperative complications were observed in 2.6% of cases (11), with injury of the donor kidney (5; 1.2%) and acute hemorrhage (3; 0.7%) being the most common complications. Postoperative complications were hematomas (32; 7.7%), seromas (28; 6.7%), and wound infections (7; 1.7%). Except for a single surgical revision owing to colon perforation (1; 0.002%), no other major complications (Clavien–Dindo ≥ IIIa) were observed in any of the donors. The donor’s and recipient’s median estimated glomerular filtration rate at discharge was 55 (29–114) and 51 (14–129) ml/min/1.73 m2, respectively. Initial nonfunction occurred in seven cases (1.6%).ConclusionsUnlike the endoscopic technique, SPEM is equally suitable for right- and left-sided nephrectomy. SPEM nephrectomy is safe and results in minimal trauma. Despite performing SPEM nephrectomy in the era of endoscopic surgery, this technique provides excellent results with regard to donor and graft outcomes.

Paired Remote Ischemic Preconditioning in Recipients and Living Donors Can Mitigate Cardiovascular Stress in Recipients After Living-Donor Kidney Transplantation: A Propensity-Score-Matching Analysis.

Background and Objectives: This study explored the effect of paired remote ischemic preconditioning (RIPC), involving both recipients and living donors, on cardiovascular stress in recipients after living-donor kidney transplantation (LDKT). The analysis included an assessment of the impact on cardiovascular biomarkers and post-transplant cardiovascular clinical events. Materials and Methods: A retrospective observational cohort study of 520 adult LDKT patients was conducted, employing propensity score matching (PSM) to analyze perioperative factors. The patients were allocated to no-RIPC (n = 260) and paired-RIPC (n = 260) groups. The two groups were compared with respect to high-sensitivity troponin I (hsTnI) and B-type natriuretic peptide (BNP) levels, corrected QT (QTc) intervals, the occurrence of arrhythmia, and the requirement for cardiovascular interventions. Results: After PSM, there were no significant differences in perioperative parameters between the no-RIPC and paired-RIPC groups. However, on postoperative day (POD) 1, higher hsTnI levels and QTc interval prolongation, as well as higher incidences of arrhythmia and the need for percutaneous coronary intervention (PCI), were determined in the no-RIPC group than in the paired-RIPC group. The associations between paired RIPC and improved cardiovascular outcomes were significant, including reduced odds of elevated hsTnI levels, QTc prolongation, and arrhythmia. The no-RIPC group also had longer intensive care unit (ICU) stays, and higher rates of rescue dialysis. Conclusions: Paired-RIPC involving recipients and donors effectively reduces cardiovascular stress markers and improves postoperative cardiovascular outcomes in LDKT recipients, underscoring its potential as a protective strategy against perioperative cardiovascular risks.