Potential Living Kidney Donors Research Articles

#2287 Impact of renal reserve before donation in post-transplant renal function of donors and recipients

Abstract Background and Aims The influence of Renal Reserve (RR), i.e. its presence or absence, in post-transplant renal function both in living kidney donors and recipients is unknown. The presence of RR in donors may be beneficial in terms of better renal function both for the donor and recipient after transplantation. In the other hand, the absence of RR in donors might indicate a lower renal endowment and so predispose to lower GFR post-transplantation in donors and recipients. However, little evidence is available in this field. Method In a previous study (ERA Abstract 2023, #3737) we described in a group of 52 potential living kidney donors, the presence (24-46%), absence (13-25%) or use (15-29%) of RR before donation. The latter was defined as the lack of increase in GFR after stimulation in patients with basal GFR > 100 mL/min. GFR was measured before and after transplantation by the clearance of iohexol with dried blood spots. Presence of RR was defined as an increase >10% of basal GFR after IV amino acid infusion. GFR was unadjusted to body surface area (BSA). In this follow-up study we investigated the impact of the presence, absence or use of RR before donation in GFR 12 months after transplantation, both in donors and recipients. Results Of the 52 pairs of donors and recipients, renal transplantation was performed in 21 who also had 12 months of follow-up. Before transplantation 9 donors had RR, 4 did not and 8 had RR in use. Pre-transplant GFR was 95 ± 15 ml/min, 89 ± 6 ml/min and 127 ± 16 ml/min in donors with RR, without RR and with RR in use, respectively. At 12 months after kidney donation, GFR was higher in donors who had RR in use before donation: 79 ± 12 ml/min, compared with those with RR: 65 ± 9 ml/min (p = 0.048) and those without RR 59 ± 10 (p = 0.03). In recipients, GFR was comparable between those who had a donor with RR or RR in use: 72 ± 19 ml/min vs 68 ± 12 ml/min (p = ns), whereas both groups had higher GFR than those recipients whose donors had no RR before donation 53 ± 5 ml/min, although of borderline signification (p = 0.07). Non parametric tests were used. No major complications after transplantations such as rejections or surgical complications, etc, that could alter GFR were observed. Conclusion The presence or use of RR may determine a better renal function 12 months after donation both for donors and recipients. This is a preliminary study and we acknowledge that the low number of cases is a limitation and so, these results require further studies.

Preoperatively determining renal perfusion and visualizing renal arteries and any abnormalities in potential living kidney donors using non-contrast-enhanced magnetic resonance imaging techniques at 1.5 Tesla

Abstract Background The aim of this work was to create and evaluate a preoperative non-contrast-enhanced (CE) magnetic resonance imaging (MRI)/angiography (MRA) protocol to assess renal function and visualize renal arteries and any abnormalities in potential living kidney donors. Methods In total, 28 subjects were examined using scintigraphy to determine renal function. In addition, 3D-pseudocontinuous arterial spin labeling (pCASL), a 2D-non-CE electrocardiogram triggered radial quiescent interval slice-selective (QISS-MRA), and 4D-CE time-resolved angiography with interleaved stochastic trajectories (CE-MRA) were performed to assess renal perfusion, visualize renal arteries, and detect any abnormalities. Two glomerular filtration rates (described by Gates, GFRG, and according to the Chronic Kidney Disease Epidemiology Collaboration formula, GFRCKD-EPI). The renal volumes were determined using both MRA techniques. Results The mean value of regional renal blood flow (rRBF) on the right side was significantly higher than that on the left. The agreements between QISS-MRA and CE-MRA concerning the assessment of absence or presence of an aberrant artery and renal arterial stenosis were perfect. The mean renal volumes measured in the right kidney with QISS-MRA were lower than the corresponding values of CE-MRA. In contrast, the mean renal volumes measured in the left kidney with both MRA techniques were similar. The correlation between the GFRG and rRBF was compared in the same manner as that between GFRCKD-EPI and rRBF. Conclusion The combination of pCASL and QISS-MRA constitute a reliable preoperative protocol with a total measurement time of less than 10 min without the potential side effects of gadolinium-based contrast agents or radiation exposure.

Nutrition Evaluation and Counseling for Potential Living Kidney Donors: An Opportunity for Lifelong Change

Abstract Purpose of Review In this review, we discuss the importance of nutrition evaluation and counseling for living kidney donor candidates (LKDCs) and the roles of the dietitian and transplant physician. Recent Findings In the past decades, living kidney donors are becoming older and have higher rates of obesity and glucose intolerance. Like all adult populations, living kidney donors are at risk for developing diabetes, obesity, hypertension, and kidney disease post-donation, and risks may rise as these chronic diseases rise in the general population. Further, implications may be more serious for individuals living with one kidney. However, involvement of the dietitian in the evaluation of LKDCs may vary across transplant centers. Current US policies do not absolutely require a Registered (Transplant) Dietitian to be involved in the care of LKDCs during the various phases of donation. Summary Dietitians should be involved in the evaluation of all LKDCs. Individualized lifestyle-focused, sustainable nutrition counseling should be provided to all LKDCs. Transplant clinicians should engage in nutrition counseling of LKDCs as this can increase the impact of the intervention. Nutrition evaluation and counseling can lead to life-long change for the LKDC.

Accuracy of eGFR Equation for Predicting Glomeruloar Filtration Rate in Potential Living Kidney Donor

This Descriptive Cross-Sectional Study, involving 201 patients, conducted at Sindh Institute of Urology and Transplantation (SIUT) Karachi, Pakistan after approval from institute research board. The estimated Glomerular Filtration Rate (eGFR) was calculated using the appropriate equation. Participants were instructed to collect their urine over a 24-hour period in a container devoid of any additives or preservatives. The collected urine specimens were subsequently sent to the institutional laboratory for analysis, with GFR determined based on 24-hour urine creatinine clearance to ensure accuracy. All data collected during the study period were meticulously entered into a predefined proforma, which was then electronically stored and utilized for research purposes.
 Results: Mean ± SD of age was 33.30±9.12 years. Out of 201 patients, 124 (61.7%) were male while 77 (38.3%) were female. In distribution of accuracy of eGFR by CKD-EPI equation, accuracy of (Cr-Cys) equation was noted as 60 (29.9%), (Cys) as 47 (23.4%) while accuracy of CKD- EPI (PK) equation was documented as 96 (47.8%).
 Conclusion: It is to be concluded that accuracy of CKD-EPI is closer to 24 -h urinary creatinine clearance in the calculation of eGFR. However, none of the eGFR formulas can be used in renal transplant donors because of their low accuracy, and 24-h urine creatinine clearance should be used for evaluation of the GFR in this population.

Pre-donation Assessment of Cystatin C to Improve Prediction of Pre- and Post-Donation GFR in Potential Living Kidney Donors.

Accurate estimation of glomerular filtration rate (GFR) is crucial in living kidney donation. While most eGFR equations are based on plasma creatinine, its levels are strongly influenced by muscle mass. Application of cystatin C (CysC)-based estimates before donation may improve both estimation of current GFR and prediction of post-donation GFR. We assessed the performance of CKD-EPI equations based on creatinine (eGFRcreat-2009, eGFRcreat-2021), cystatin C (eGFRCysC-2012), or both (eGFRcombined-2012, eGFRcombined-2021) for estimating pre- and post-donation measured GFR in 486 living kidney donors. We subsequently focused on a subgroup of individuals with high/low muscle mass (25% highest/lowest 24-hour urinary creatinine excretion, sex-stratified and height-indexed). Pre-donation eGFRcombined 2012 and eGFRcombined 2021 showed the strongest associations with pre- and post-donation mGFR. Pre-donation eGFRcombined 2021 was most accurate for estimating both pre-donation (bias 0.01±11.9 mL/min/1.73m2) and post-donation mGFR (bias 1.3±8.5 mL/min/1.73 m2). In donors with high/low muscle mass, CysC-based equations (with or without creatinine) performed better compared to equations based on only creatinine. In conclusion, combined eGFR equations yielded a better estimate of pre- and post-donation mGFR, compared to estimates based on creatinine or CysC only. The added value of CysC seems particularly pronounced in donors with high or low muscle mass.

Navigating Living Kidney Donation and Transplantation Among South Asian Canadians: The ACTION Project

South Asian (SA) Canadians with kidney failure have a 50-77% lower likelihood of kidney transplantation and are less likely to identify potential living kidney donors (LDs). This study aimed to identify, health system, patient, and community level barriers and facilitators for accessing living donor kidney transplantation (LDKT) in the SA community to inform the development of health system and community level interventions to address barriers. Qualitative study. & Participants: 20 SA recipients of a living or deceased donor kidney transplant, 10 SA LDs, and 41 general SA community members. In-depth multi-lingual interviews were conducted with recipients and LDs. Gender, language, and age-stratified focus groups were conducted with general SA community members. Summative content analysis was used to analyze the data. Hesitancy in approaching potential donors, fear about the health of potential LDs, information gaps, language barriers, and challenges evaluating out-of-country donors were highlighted as significant barriers by recipients, while financial concerns and information gaps were identified by donors. Cultural barriers in the SA community were highlighted by donors, recipients, and community members as critical factors when considering donation and transplantation; women and elderly SA Canadians highlighted nuanced challenges. Participants reported generally a favorable perception of their healthcare teams, citing SA representation in the teams as important to providing culturally and linguistically sensitive care. Limited geographic, race, and cultural representation and reliance on virtual data collection. This study highlights several culturally relevant barriers to donation and transplantation that are potentially modifiable through patient, health system, and community-focused engagement and education.

Performance of the race-free CKD-EPI creatinine-based eGFR equation in a Danish cohort with measured GFR.

In 2021, an updated Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation for estimated glomerular filtration rate (eGFR) without a coefficient for race (CKD-EPI21) was developed. The performance of this new equation has yet to be examined among specific patient groups. We compared the performances of the new CKD-EPI21 equation and the 2009 equation assuming non-Black race (CKD-EPI09-NB) in patients with GFR measured by chromium-51-EDTA plasma clearance at Aarhus University Hospital in Denmark during 2010-18. We examined bias, accuracy, precision and correct classification of chronic kidney disease (CKD) stage using chromium-51-EDTA clearance as the reference standard. We assessed the performance in the total cohort, cancer patients and potential living kidney donors. We also assessed the performance stratified by CKD stage in the total cohort. In this predominantly white population, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation in both the total cohort (N=4668), and in cancer patients (N=3313) and potential living kidney donors (N=239). In the total cohort, the CKD-EPI21 equation demonstrated a slightly lower median absolute bias (-0.2 versus -4.4mL/min/1.73 m2), and a similar accuracy, precision and correct classification of CKD stage compared with the CKD-EPI09-NB equation. When stratified by CKD stage, the CKD-EPI09-NB equation performed slightly better than the CKD-EPI21 equation among patients with a measured GFR (mGFR) <60mL/min/1.73 m2. In a selected cohort of Danish patients with mGFR, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation except for patients with a mGFR <60mL/min/1.73 m2, where CKD-EPI09-NB performed slightly better although the differences were considered clinically insignificant.

Reasons and effects of the decline of willing related potential living kidney donors.

Although the availability of related living donors (LDs) provides a better chance for receiving kidney transplantation (KT), the evaluation protocols for LD selection remain a safeguard for the LD's safety. These protocols are variable from one center to another, resulting in variable rates of decline of the potential LDs (PLDs). The decline of willing PLDs may occur at any stage of evaluation, starting from the initial contact and counseling to the day of operation. To identify the causes of the decline of PLDs, the predictors of PLD candidacy, and the effect on achieving LDKT. A retrospective study was performed on the willing PLDs who attended our outpatient clinic for kidney donation to their related potential recipients between October 2015 and December 2022. The variables influencing their candidacy rate and the fate of their potential recipients were studied. Two groups of PLDs were compared: Candidate PLDs after a completed evaluation vs non-candidate PLDs with a complete or incomplete evaluation. A multivariate logistic regression was performed to assess the factors contributing to the achievement of PLD candidacy. Of 321 willing PLDs, 257 PLDs (80.1%) accessed the evaluation to variable extents for 212 potential recipients, with a mean age (range) of 40.5 ± 10.4 (18-65) years, including 169 females (65.8%). The remaining 64 PLDs (19.9%) did not access the evaluation. Only 58 PLDs (18.1%) succeeded in donating, but 199 PDLs (62.0%) were declined; exclusion occurred in 144 PLDs (56.0%) for immunological causes (37.5%), medical causes (54.9%), combined causes (9.7%), and financial causes (2.1%). Regression and release occurred in 55 PLDs (17.1%). The potential recipients with candidate PLDs were not significantly different from those with non-candidate PLDs, except in age (P = 0.041), rates of completed evaluation, and exclusion of PLDs (P < 0.001). There were no factors that independently influenced the rate of PLD candidacy. Most patients who failed to have KT after the decline of their PLDs remained on hemodialysis for 6 mo to 6 years. The rate of decline of willing related PLDs was high due to medical or immunological contraindications, release, or regression of PLDs. It reduced the chances of high percentages of potential recipients in LDKT.

Coronary Computed Tomography Angiography and Abdominal Aortic Calcification Screening among High-Risk Living Kidney Donors

Background: A unique scanning protocol combining coronary computed tomography angiography (CTA) with routine abdominal CTA is being used at the Rabin Medical Center as a method of screening high-risk candidates for living kidney donation. We aim to evaluate the potential impact of coronary CTA on the decision regarding eligibility for kidney donation and its correlation with abdominal aortic calcification (AAC). Methods: CCTA and abdominal CTA results of potential living kidney donors evaluated for donation between September 2020 and November 2021 were retrieved. A retrospective analysis of the abdominal CTA was used to calculate the AAC. Patients’ demographic, clinical, and imaging data were collected from the electronic files, as well as the final decision regarding eligibility for donation. Results: A total of 62 potential kidney donors were evaluated for donation using the combined scan. The mean age was 53.8 years, with male predominance (59.7%). Significant coronary artery stenosis (≥70% luminal stenosis) was present in two patients (3.2%), whereas five patients (8%) had moderate stenosis (50–69%). Thirteen patients (21%) were disqualified from donation due to moderate-to-significant coronary artery disease or abdominal atherosclerosis. The correlation between the coronary artery calcium score and the AAC was found to be positive, with a Pearson correlation coefficient of 0.88 (p &lt; 0.001). Conclusions: The use of coronary CTA in the evaluation of potential kidney donors may has a potential impact on the decision regarding eligibility for donation. A high correlation between the coronary artery calcium score and the AAC was found.

How the websites of high-volume US centers address the risks of living kidney donation.

The websites of US transplant centers may be a source of information about the renal risks of potential living kidney donors. To include only likely best practices, we surveyed websites of centers that performed at least 50 living donor kidney transplants per year. We tabulated how risks were conveyed regarding loss of eGFR at donation, the adequacy of long-term ESRD risk data, long-term donor mortality, minority donor ESRD risk, concerns about hyperfiltration injury versus the risk of end-stage kidney diseases, comparisons of ESRD risks in donors to population risks, the increased risks of younger donors, an effect of the donation itself to increase risk, quantifying risks over specific intervals, and a lengthening list of small post-donation medical risks and metabolic changes of uncertain significance. While websites had no formal obligation to address donor risks, many offered abundant information. Some conveyed OPTN-mandated requirements for counseling individual donor candidates. While actual wording often varied, there was general agreement on many issues. We occasionally noted clear-cut differences among websites in risk characterization and other outliers. The websites of the most active US centers offer insights into how transplant professionals view living kidney donor risk. Website content may merit further study.

Eliminating financial disincentives to living kidney donation - a call to action.

The incidence of end stage renal disease (ESRD) in the United States (US) is increasing each year. The lone curative treatment for ESRD remains kidney transplantation. Despite the demonstrated medical and economic benefits, living donor kidney transplantation (LDKT) only accounts for a small number of kidney transplantations each year. Direct and indirect costs exist that disincentivize potential living kidney donors from coming forward, such as the cost of travel and lodging, risk of death, potential loss of income due to an extended recovery time, and the inability to donate to a relative in the future if needed. Herein, we advocate for policy changes that make living kidney donation (LKD) a financially neutral process thereby incentivizing increased LDKT and mitigating the kidney donor shortage.

Comparison of Three Glomerular Filtration Rate Estimating Equations with 24-Hour Urine Creatinine Clearance Measurement in Potential Living Kidney Donors.

The accuracy of the measurement of renal function in potential living kidney donors (PLKD) is essential. The direct measurement of glomerular filtration rate (mGFR) has been considered the "gold standard." The estimated GFR (eGFR) with 24-hour urinary creatinine clearance (CrCl) is frequently used because of its availability. We aim to evaluate the correlation and agreement of eGFR using serum-based creatinine formulas (Cockcroft-Gault, MDRD, and CKD-EPI) and the eGFR based on 24-hour urinary CrCl to evaluate kidney function in PLKD. We evaluated the kidney function in 799 PLKD using 24-hour urinary CrCl method and compared the correlation and agreement with the eGFR based on creatinine formulas (Cockcroft-Gault, MDRD, and CKD-EPI). We calculated the mean bias (difference), precision (SD of this difference), accuracy, and performed Bland-Altman plots. A total of 799 PLKD were analyzed. The age of the PLKD ranged from 18 to 73 years. Weak to mild correlation was observed between 24-hour urinary CrCl and all formulas (ranged from 0.31 to 0.49). The three equations underestimated the GFR. Using the Bland-Altman graphic, we observed that the CKD-EPI was the least scattered and most precise; however, mean bias and the interval range (limits of agreement) of all formulas were too big to assume equivalence between 24-hour urinary CrCl method and eGFR based on creatinine. Results of mean bias were similar when comparing the three equations in patients with CrCl GFR <60. However, the accuracy of all formulas was better for the female group and the youngest individuals (≤40 years old). In this PLKD cohort, of all the three equations, the CKD-EPI was the least scattered and most precise. However, the correlation and the level of agreement between the three equations and 24-hour urinary CrCl were too low to assume the equivalence.

#3193 PERFORMANCE OF THE RACE-FREE CKD-EPI CREATININE-BASED EGFR EQUATION IN A DANISH COHORT WITH CHROMIUM-51-EDTA CLEARANCE MEASUREMENTS

Abstract Background and Aims In 2021, an updated estimated glomerular filtration rate (eGFR) equation based on serum creatinine, age, and sex, but without a coefficient for race (CKD-EPI21) was developed and recommended for clinical use. However, the performance of the new equation has yet to be examined among specific groups such as patients with cancer. Method We compared the performances of the CKD-EPI21 equation and the original creatinine-based eGFR equation assuming non-Black race (CKD-EPI09-NB) in patients ≥18 years of age with measured GFR ascertained by chromium-51-EDTA plasma clearance at Aarhus University Hospital in Denmark during 2010–2018. We examined bias, accuracy, precision (defined as the interquartile range of the absolute bias), and correct classification of chronic kidney disease (CKD) stages (GFR ≥60, 30–59, and &amp;lt;30 ml/min/1.73 m2) using the chromium-51-EDTA clearance as the reference standard. Furthermore, we assessed the performance of the equations in the total cohort while stratifying by CKD stage. We assessed the performance in the total cohort and in cohorts of cancer patients and potential living kidney donors. Results In this predominantly White population, the CKD-EPI21 equation performed slightly better than the CKD-EPI09-NB equation, both when examining the total cohort (N = 4,668) and when examining cohorts of cancer patients (N = 3,313) and potential living kidney donors (N = 239). In the total cohort, the CKD-EPI21 equation demonstrated lower median absolute bias (−0.2 versus −4.4 ml/min/1.73 m2), higher accuracy (72% versus 70%) as well as equal precision (25 versus 25 ml/min/1.73 m2) and correct classification of CKD stages (86% versus 85%) when compared with the CKD-EPI09-NB equation. When we stratified by CKD stage, the CKD-EPI09-NB equation performed slightly better than the CKD-EPI21 equation among patients with a GFR &amp;lt; 60 ml/min/1.73 m2. Conclusion In a selected cohort of Danish patients with measured GFR, the CKD-EPI21 equation performed slightly better than the CKD-EPI21-NB equation except for patients with a GFR &amp;lt; 60 ml/min/1.73 m2.

#6668 PREDICTION OF REMAINING RENAL FUNCTION IN PATIENTS UNDERGOING RADICAL NEPHRECTOMY DUE TO RENAL TUMOUR MASS AND AFTER NEPHRECTOMY IN LIVING DONORS

Abstract Background and Aims Accurate assessment of renal function is of great importance in clinical practise, in particular in patients undergoing nephrectomy due to tumor nephrectomy or in potential living kidney donors. In both cases, residual renal function is dependent on the remaining nephron number and their function. A reliable prediction of the post-nephrectomy kidney function would be of great help to identify the patient with an increased functional risk. The aim of this study was to assess if the short-term kidney function after nephrectomy can be reliably predicted. Method We performed a retrospective study in 68 living kidney donors (LD-Nx) and 43 patients undergoing nephrectomy due to a renal tumour (Tu-Nx) between 1st of January 2011 to 31st of December 2015 at the University Hospital Zurich. Baseline serum creatinine was defined as lowest observed serum creatinine value before LD-Nx and Tu-Nx and was used for calculation of estimated glomerular filtration rate (eGFR) by the Cockroft-Gault (CG) and Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formulas. The expected post-nephrectomy kidney function was calculated based on the formula (expected eGFRpost = 0.6 * eGFRpre + 8.7) described in detail in: (Prediction of kidney function after nephrectomy was performed by using the formulas previosly established by our group [1]). Expected eGFR was calculated for CG and CKD-EPI formulas and expected serum creatinine was calculated from the expected eGFR based on CG formula. The expected kidney function was then compared to the observed kdiney function based on lowest observed serum creatinine (LoObsSCr) during the first year after nephrectomy and the corresponding eGFR values for CG and CKD-EPI were calculated. Results Patients with nephrectomy due to renal tumour had significantly higher baseline serum creatinine levels compared to living donors (100±50 umol/l vs. 70±12 umol/l, respectively) with 35% having proteinuria, 58% hypertension and 14% diabetes mellitus. In addition Tu-Nx patients were significantly older and had a higher body weight. Living donors had a higher percentage of smokers (31%) compared to the other group. Predonation eGFR CKD-EPI was 71±23 ml/min/1.73 m2 for Tu-Nx and 94±12 ml/min/1.73 m2 for LD-Nx patients. Both groups showed an adaptive increase in kidney function calculated by eGFR CKD-EPI: 29% for Tu-Nx and 14% for LD-Nx. LD-Nx patients had less bias in prediction of post-nephrectomy kidney function (Table 1). Lowest observed serum creatinine after nephrectomy did not significantly differ between the groups. A significant correlation between expected and observed serum creatinine values, as well as between expected and observed eGFR post-nephrectomy, was seen in both groups of patients. Conclusion Despite older age, higher body weight and more comorbidities, patients with tumor nephrectomy show an adaptive increase in kidney function. Prediction of kidney function after nephrectomy is possible for both groups, however more accurate for living donor patients.

#6880 PREDICTION OF GRAFT SURVIVAL PRIOR TO ACCEPTING AN OFFER FOR LIVING DONOR KIDNEY TRANSPLANT: AN ARTIFICIAL INTELLIGENCE APPROACH

Abstract Background and Aims The current available models for evaluation of outcomes of living donor kidney transplant before accepting an offer are poorly developed, reported, validated and have small sample sizes. We aim to use Artificial Intelligence to build a model that can accurately predict death censored graft survival for living donor kidney transplant prior to accepting an offer. Method All living kidney transplant patients who were: registered in the UNOS database between 1/1/2007 and 1/6/2021, maintained on TAC/MMF immunotherapy were included in our analysis. We excluded patients with age&amp;lt;18 years old and ABO incompatible transplant. We divided the data randomly into training and testing dataset with ratio 80:20. We performed recursive feature elimination to select the important ones for prediction. Features were selected based on their Gini impurity scores. We performed Artificial Neural Network analysis (ANN). We evaluated the model using Harrell Concordance-time-dependent score (for discrimination), and Integrated Brier score (for calibration). We also assessed dynamic AUC for model performance. Results 54,110 living donor kidney transplant patients were included in the study. Harrell C-Statistic scores were 0.70 at 5 years post-transplant, 0.68 at 10 years post-transplant and 0.68 at 13 years post-transplant, indicating very high discrimination power. Integrated Brier Score was 0.08, indicating very high calibration score for our model. Dynamic AUC scores were 0.71 at 5 years post-transplant and 0.68 at 10- and 13-years post-transplant, indicating adequate performance for our model. The key players in our model were recipient age (variable importance = 0.26), donor age (variable importance = 0.17), donor ethnicity (variable importance = 0.90), followed by dialysis vintage pre-transplantation. Conclusion The ANN model had high discrimination, calibration, and performance indices for predicting death censored graft survival prior to transplant. It can aid the clinical decision for management of the transplant patients. We are currently developing a user-friendly web application that can be used to apply the ANN model for prediction. Our model can help ranking potential living kidney donors based on graft outcomes. Therefore, our model can help improve current outcomes of kidney paired exchange schemes.

Lithium and the living kidney donor: Science or stigma?

Nearly 10 000 people are removed from the kidney transplant waiting list each year either due to becoming too ill for transplant or due to death. Live donor kidney transplant (LDKT) provides superior outcomes and survival benefit relative to deceased donor transplant, but the number of LDKT has decreased over the past few years. Therefore, it is of paramount importance that transplant centers employ evaluation processes that safely maximize LDKT. Decisions about donor candidacy should be based on the best available data, rather than on processes prone to bias. Here, we examine the common practice of declining potential donors based solely on treatment with lithium. We conclude that the risk of end-stage renal disease related to lithium treatment is comparable to other generally accepted risks in LDKT. We present this viewpoint to specifically challenge the carte blanche exclusion of individuals taking lithium and highlight the importance of using the best available data relevant to any risk factor, rather than relying on biases, when evaluating potential living kidney donors.

An evaluation of the contribution of routine ultrasound when performed with multiphase CT in renal donor imaging assessment.

We sought to examine the contribution of routine ultrasound when performed with computed tomography in identifying exclusion criteria in potential living kidney donors. We performed a 10-year retrospective cohort study including all cases of potential renal donors at our center. For each case, the donor workup ultrasound (US) and multiphase computed tomography (MPCT) original reports and imaging were reviewed by a fellowship-trained abdominal radiologist in consultation with a transplant urologist and placed into one of 3 groups: (1) no significant US contribution, (2) US was useful to characterize an incidental finding (either US exclusive or US aided in CT interpretation) but did not impact donor eligibility, and (3) an US exclusive finding contributed to donor exclusion. A total of 432 potential live renal donors were evaluated (mean age 41, 263 women). In total, 340 (78.7%, group 1) cases had no significant US contribution. In 90 cases (20.8%, group 2), US helped to characterize one or more incidental findings but did not contribute to donor exclusion. In 1 (0.2%, group 3) case, an US exclusive finding (suspected medullary nephrocalcinosis) contributed towards donor exclusion. US provided limited contribution to renal donor eligibility decisions when performed routinely with MPCT. Routine ultrasound could potentially be omitted in the live renal donor workup, with alternative strategies including a selective approach to incorporating ultrasound and an expanded role of dual-energy CT. • Ultrasound is performed routinely with CT for renal donor assessment in some jurisdictions; however, this practice has come into question particularly with advances in dual-energy CT. • Our study found that routine use of ultrasound provided limited contribution, primarily assisting CT in characterization of benign findings with only 1/432 (0.2%) potential donors in a 10-year period excluded based in part on an ultrasound exclusive finding. • The role of ultrasound can be narrowed to a targeted approach for certain at-risk patients, and can be further reduced if dual-energy CT is utilized.

Evaluacija davalaca kompjuterizovanom tomografijom u sklopu preoperativne pripreme za presađivanje bubrega sa živog davaoca

Kidney transplantation is the therapeutic method of choice in end-stage kidney disease. Preoperative preparation includes a number of examinations, with the radiologists being responsible for accurate imaging evaluation. Computed tomography (CT) is the preferred imaging modality for preoperative renal evaluation and it is the gold standard. Radiological evaluation includes insight into all focal and diffuse diseases of the renal parenchyma, as well as reporting about anatomy, anomalies, the collecting system, and vasculature. A careful insight into the vascular structures of the kidney is possibly the most important step because it helps the surgeon prepare for potential difficulties before the procedure, therefore reducing the risk of potential complications. This is why radiological evaluation of the potential living kidney donor is essential for successful transplantation. The key to accurate radiological reporting is knowledge of surgical techniques and of the difficulties that surgeons may face during the kidney transplantation procedure.

Characteristics of Potential and Actual Living Kidney Donors: A Single-center Experience.

There are limited data and no national capture of barriers associated with initiating and completing the donation process for potential living kidney donors (LKDs). We performed a retrospective analysis of 3001 intake forms completed by prospective LKDs from 2016 to 2019 at a single transplant center. We analyzed data from all potential donors who completed the intake until they became ineligible or withdrew or donation was complete. We used univariate and multivariate models to evaluate independent factors associated with donation at various stages in the donation process. The donation process was deconstructed into 5 steps: intake form, immunologic compatibility testing, clinic evaluation, selection committee review, and donation. The highest percentage of potential donors dropped out after completing the intake form, primarily because of not responding to the follow-up phone call (22.6%). Of 455 potential LKDs that completed immunologic compatibility testing, 36% were ABO or crossmatch incompatible. One-hundred eighty-eight (7.5%) of all LKD applicants reached donation, the majority of whom were White (91.0%) and female (63.8%). A minority of LKD applicants make it to donation. Our ability to track all potential LKDs from the initial touch point to the transplant center will help us develop interventions to address barriers to a successful donation.

Timed Creatinine Clearance and Measured Glomerular Filtration Rate in Living Kidney Donors

Assessment of predonation glomerular filtration rate (GFR) is a key aspect of the evaluation of potential living kidney donors. In the United States, measurement of donor GFR is a regulatory requirement and most commonly assessed using 24-hour timed creatinine clearance (CrCl24), despite the potential for error due to incorrectly timed urine sample collection and tubular creatinine secretion.1,2 We aimed to determine the real-world performance of CrCl24 in living donor candidates.