Renal Donors Research Articles

PS-R07-10: A MOTHER AND HER DAUGHTER CASES OF PRIMARY ALDOSTERONISM

The majority of cases of primary aldosteronism (PA) occur sporadically. Familial forms of PA are rare with four subtypes defined. We reported a case of familial cluster of primary aldosteronism in two members, daughter and her mother. Case presentation Case 1: Daughter A 20-year-old woman with a history of hypertension and proteinuria for three years without treatment, was admitted for the treatment of accelerated hypertension of 182/121 mmHg and end stage kidney disease. Blood examination revealed low plasma renin activity (PRA) of 0.7 ng/ml/h, and high plasma aldosterone concentration (PAC) of 349 pg/mL, high aldosterone/renin ratio (ARR) of 498.6, and serum potassium (sK) of 4.9 mEq/L. (Plasma ACTH 12.9 pg /mL, plasma cortisol 7.4 mcg/dL) These findings suggested PA. Abdominal CT scan showed no adrenal mass. After control of accelerated hypertension with nifedipine GITS and alpha adrenoceptor blocker, confirmatory tests for PA, saline infusion test (SIT) were carried out and was positive test (PAC 240 min after infusion 264pg/mL). Adrenal venous sampling revealed bilateral hyper-aldosterone secretion. She was given diagnosis of bilateral adrenal hyperaldosteronism. Her blood pressure was decreased to 118/77 along with administration of spironolactone 25 mg/day. Her parents have hypertension. We investigate the cause of hypertension in her parents. Blood test of her father revealed PRA 3.4 ng/m/h, PAC 18.3 pg/ml, and sK 4.7 mEq/L. Case 2: Mother A 45-year-old women with hypertension treated with amlodipine 5 mg was referred to our hospital to examine the renal function after renal donation to her daughter. Blood test revealed mild renal dysfunction (eGFR 72,2), normal sK(4.0 mEq/L), low PRA (0.9 ng/ml/h), high PAC (118 pg/mL) for high salt intake (11.6 g/day as high as salt loading test). Abdominal CT scan showed no adrenal mass. SIT was positive (PAC 240 min after infusion 60.0 pg/mL). She was given diagnosis of PA. Discussion: Potential factors leading to BHA include rare disease-predisposing germline variants, circulating angiotensin II type 1 receptor autoantibodies, and paracrine activation of aldosterone production by adrenal mast cells have been reported. Primary hyperaldosteronism in 2 family members, a mother and daughter, suggests familial hyperaldosteronism which caused by germline mutation. We now investigate germline variants for BHA.

Latent Tuberculosis Infection in Potential Renal Transplant Recipients and Live Donors in a Tertiary Level Transplant Center in Nepal

Background: Active tuberculosis in transplant recipients can result from latent infection with Mycobacterium Tuberculosis in the transplant recipients, donor tissue, or de novo post-transplant infection. This study aimed to determine the prevalence of latent tuberculosis infection in potential renal transplant recipients and live donors at a tertiary-level transplant center.
 Materials and Methods: This observational study was conducted from July to October 2020 among 72 potential kidney transplant recipients and their potential donors from the Department of Nephrology, Tribhuvan University Teaching Hospital. The biochemical parameters and health behaviors were measured to find the association with latent tuberculosis infection.
 Results: The prevalence of latent tuberculosis infection according to Mycobacterium tuberculosis-specific interferon-gamma release assays was 20.8% in potential recipients and 16.6% in potential donors, whereas the prevalence with tuberculin skin test was 9.7% in potential recipients and 33.3% in potential donors. Low levels of hemoglobin, calcium, albumin, vitamin D and history of smoking were associated with the development of latent tuberculosis infection among potential recipients. Alcohol drinking was significantly associated with the development of latent tuberculosis infection among donors.
 Conclusion: Potential renal transplant recipients and donors have a significant burden of latent tuberculosis in the pre-transplantation phase. Diagnosis and treatment of latent tuberculosis before transplantation can prevent ominous complications.

Correlation of Differential Function and Glomerular Filtration Rate Estimated from Computed Tomography based Renal Volume and Diuretic Renogram in Living Renal Donor

Introduction: In renal transplant, serum creatinine and isotope studies are used for determination of donor glomerular filtration rate (GFR). Studies have shown computed tomography measured renal volume can also be used. Our main objective was to assess the accuracy of volume based estimated GFR (vGFR) with diethylene triamine penta acetic acid (DTPA) measured GFR in living kidney donors. Methods: An observational analytical study was conducted from July 2018 to June 2019 in Department of Urology and Kidney Transplant Surgery and Department of Radiodiagnosis in Tribhuvan University Teaching Hospital where a total of 38 eligible potential donors were evaluated and serum creatinine level, computed tomography with contrast and DTPA renogram were used to measure GFR and differential function. Results: The mean age of the donors were 42.8±10.9 years with 70% of donors being females. Renal volume was not statistically different between male and female donors. There was moderate correlation between volume based and DTPA based GFR (r=0.76) and differential function (r=0.71). Compared to creatinine, volume based GFR estimate showed better correlation to DTPA renogram. There was no significant difference in differential function estimated by DTPA and volume based estimates (p = 0.96). The upper and lower limit of agreement between the volume based and DTPA based differential function was –4.7 and 4.6 respectively. Conclusion: GFR measurement by CT volume overestimates total GFR compared to DTPA renogram but it has better correlation than creatinine based estimates. It can be used to estimate the differential function of the donor kidney.

Peri-hilar branching pattern and variations of the renal artery among Indian kidney donors using pre-operative computed tomography angiography: an anatomical study and review.

The peri-hilar branching pattern of renal arteries and variations such as accessory renal artery and early branching of the renal artery are important factors to be evaluated preoperatively to minimise potential complications during renal transplantation and renal surgeries. The present study was done to assess the peri hilar branching pattern of the renal artery and its variation among the renal donors in India. One hundred ninety eight kidneys from 99 donors were analysed using pre-operative computed tomography renal angiograms prospectively, over 1 year 2 months. Based on the branching pattern of primary and secondary branches of renal arteries, we identified 8 cardinal and 10 minor peri-hilar branching patterns. Type I (duplicated fork) peri-hilar branching pattern was the most frequently found (70.2%) among 198 kidneys, followed by type II (triplicated fork) (19.2%) and type III (ladder) (10.6%). Duplicated fork pattern was common in both the right renal artery (75.7%) and left renal artery (64.6%), respectively. The prevalence of accessory renal artery was 39.4% with hilar artery at 21.2% and polar artery at 18.2%, and the prevalence of early division of renal artery was 20.2%. No significant association was found between gender and laterality in the prevalence of both early division and accessory renal artery (p > 0.05). Early division of renal artery was more frequent in females (28%) whilst accessory renal arteries were more common in males (40.7%). The present study showed a consistent peri-hilar branching pattern with high individual variability among Indian renal donors. The knowledge about the peri-hilar branching pattern as well as renal artery variations conferred by this study would greatly compliment urological surgeons during renal transplant surgeries.

QuantiFERON cytomegalovirus assay for evaluation of CMV reactivity among renal transplant recipient and donor in Bangladesh

Farnaz Nobi, Amit Bari, Nura Afza Salma Begum, Tasnuva Sarah Kashem, Mohammad Shakib Uz-Zaman Arefin, Shoeb Nomany, Mitali Rahman, Niyoti Akhter, Eshaba Yousuf, Harun Ur Rashid. Korean J Transplant 2022;36:250. https://doi.org/10.4285/ATW2022.F-3896

Establishment of a formula for the estimation of kidney depth in adults and its effect on glomerular filtration rate assessment.

Gates' analysis method for kidney depth (KD) calculation is the only way to determine the glomerular filtration rate (GFR) of the kidney in clinical practice, which posits that the influence of KD on the GFR is more important than other factors. Computed tomography (CT) measurement of the donor KD can improve the accuracy of GFR measurement by Gates' method but will also increase the radiation exposure of kidney transplantation donors. Thus, it is particularly important to establish an accurate empirical formula for KD measurement that is more consistent with the real KD. In total, 326 potential renal transplantation donors were enrolled in this study. Among these, 167 donors were assigned to the training set to estimate the regression formula of KD measured by CT. The remaining 159 donors were included in the validation set to verify the regression formula. The KD measured by CT and its corresponding GFR was taken as the reference standard. The performances of formulas were then compared. There was no significant statistical difference between the CT-measured KD and the current fitting, Li Q, and Xue JJ formulas (P>0.05). However, significant differences were observed between the KDs calculated using the Taylor, Ma G, and Uchiyama formulas and the CT-measured reference standard KD (P<0.05). Furthermore, there was no notable difference in the GFRL and GFRR corresponding to the CT-measured KD with that of the fitting, Ma G, and Xue JJ formulas (P>0.05). There were also marked differences in the GFRR corresponding to the Li Q's formula (P<0.05), and in the GFR between other estimation methods and the CT measurement (P<0.05). The fitting formula established in this study can play a more important role if an accurate measurement method of the body thickness at the level of the hilum on the body surface can be found.

Female Renal Donors: Impact of Donation on Anxiety, Depressive Symptoms and Quality of Life

Introduction: Donating one’s kidney can be a complicated psychological experience. This study was designed to evaluate and compare anxiety, depression and quality of life of married female renal donors during the pre and post donation phase. Methods: In this prospective longitudinal observational study, 39 consecutive female renal donors were assessed using PHQ-9, HAM-A and the WHO QoL-Bref Questionnaire 2 weeks before and 3 months after kidney donation. Results: The mean age of female kidney donors was 41.74 ± 8.85. After donation, prevalence of depression increased from 43.59 % (n = 17) to 53.84 % (n = 21), (t(38) = -2.089, p = 0.04) while prevalence of anxiety in donors increased from 58.97 (n = 23) to 69.23 % (n = 27) and the difference was found to be statistically significant (t(38) = 2.47, p = 0.01). Kidney transplantation resulted in a significant decrease in overall perception score of WHOQOL-Bref Questionnaire. (t(38) = 3.504, p = 0.001), overall perception score of health (t(38) = 3.504, p = 0.001), physical domain (t(38) = 4.180, p = 0.000) and psychological domain (t(38) = 2.469, p = 0.018) after donation. There were no significant changes in the social relationship (t(38) = -0.80, p = 0.936) and environmental health domain scores (t(38) = 0.991, p = 0.328). On multiple regression analysis, presence of pre-transplant depression was independently associated with overall score of WHOQOL-Bref Questionnaire (β = -0.14, p = 0.002), perception of health (β = -0.08, p = 0.001), physical health (β = -1.91, p = 0.08) and psychological health (β = -2.57, p = 0.02). Pre-transplant anxiety was negatively related to overall perception of health (β = -0.08, p = 0.01), physical health (β = -2.05, p = 0.01) and psychological health (β = -1.94, p = 0.02). Conclusion: Significant reduction in quality of life, perception of health, physical health and psychological domain of female renal donors was observed after donation.

Laparoscopic versus Open Donor Nephrectomy

Objectives: The objective of this study is to report the difference in loss of length of the renal artery and vein between an open and laparoscopic renal donor nephrectomy. Methodology: We take 50 open and 50 laparoscopic renal donors for comparison of loss of length of the renal artery and vein. This is a single-blinded study. All patients considered for left donor nephrectomy with a single renal artery and vein are included in the study. Patients considered for right donor nephrectomy, abnormal renal artery and vein anatomy, atherosclerotic renal artery or vein are excluded from the study. Results: In our study, we take 50 open renal donor nephrectomies and 50 laparoscopic renal donor nephrectomies from a total of 115 renal donor nephrectomies from December 2020 to April 2021. For removing bias, we take only the left side nephrectomy which has a single artery and vein. We used study randomizer software which uses cluster randomization which decides case should be operated on either open or laparoscopy. Conclusions: In our study, the difference between preoperative and intraoperative artery length for open donor nephrectomy (ODN) was 0.3 cm, and vein length was 2.3 cm and the difference between preoperative and intraoperative artery length for laparoscopic donor nephrectomy (LDN) was 0.5 cm, and vein length was 2.5 cm. The difference between renal artery length in open versus LDN is 0.2 cm, and the difference between renal vein length in ODN versus LDN is 0.2 cm, which is statistically insignificant.

Transplantation in a Recipient with Crossed Renal Ectopia and Donor with Early Branching of the Left Renal Artery - A Case Report

Comprehensive preoperative evaluation of potential donors is crucial for selecting the right donor. Early segmentary arterial branching is present in 10%–12% of cases. Expert surgeons require at least 1 cm of main donor renal artery to clamp and properly anastomose the artery in the recipient. We report a case of live-related renal transplantation wherein the recipient had a crossed renal ectopia and the donor had early branching of the left renal artery (&lt;5 mm from the aorta).

Ex vivo Renal Bench Pyelolithotomy for Renal Calculi in Live Related Kidney Transplant

Background and Objectives: Bench surgery performed just after donor nephrectomy is known as ex vivo Bench Surgery. We present a case series of Bench Pyelolithotomy in donor's kidney just before transplantation with our surgical experience and follow-up results. Patients and Methods: Fifteen ex vivo Bench Pyelolithotomy on renal graft was performed by an experienced surgeon from January 2018 to August 2020. All these patients underwent standard donor evaluation and metabolic workup. Pre- and post-operative parameters were analyzed for technical feasibility, intraoperative and postoperative complications, stone clearance, and stone recurrence rate. Results: All 15 donors were females with a mean age of 44 years. The mean stone size was 14.3 mm (range 5–30 mm). Stone extraction by pyelolithotomy on the bench was successfully performed, and a stone-free status was accomplished just before the transplantation. Complete stone clearance was achieved in all cases. Mean cold ischemia time was 32 min. Postoperatively, patients were stable with average urine output of 490 ml/h. All patients are in regular follow-up with graft functioning well measured with respect to serial serum creatinine and urine output. Conclusions: Bench surgery is safe, less time-consuming, and equally effective for a stone-bearing renal donor kidney without compromising renal allograft function.

Incidence and correlates of testicular pain after kidney donation

Some kidney donors experience testicular pain after donation. We studied the presence of testicular pain in male donors from The Renal and Lung Donor Evaluation (RELIVE) Study which investigated short- and long-term outcomes of 8922 kidney donors. Of the 2551 male donors with available testicular status data included in the analysis, 54 (2.12%) developed testicular pain 19 days (IQR 7, 40) after donation: 34 had testicular pain only, 6 had epididymitis, and 14 had both. Donors developing pain were 4 years older and pain occurred more often in those undergoing laparoscopic nephrectomy; 3.6% vs. 1.1% for open nephrectomy. Non-Hispanic White ethnicity and undergoing laparoscopic nephrectomy were associated with increased risk of testicular pain; RR 5.56 (95% CI 1.35, 22.84), p=0.02, RR 3.11 (95% CI 1.71, 5.65), p&amp;lt;0.001, respectively. Laterality of nephrectomy, however, was not associated with increased risk of testicular pain. Testicular pain is not infrequent and contrary to previous reports, left nephrectomy was not associated with a higher incidence of testicular pain. Donors should be routinely asked about this potentially bothersome complication.

Comparison of Turbo Flash and dual-energy modes of third-generation dual-source CT in pre-transplant renal angiography: a prospective observational study

BackgroundThe purpose of this study was to compare the Image Quality, Contrast Medium Volume, and Radiation dose in renal angiography performed using Turbo Flash mode and dual-energy (DE) mode in the third-generation dual-source dual-energy CT.This prospective observational study was performed on renal donors who underwent CTA imaging as a pre-transplant workup. The study population was divided into two groups. Group A underwent DECT renal angiography. Group B underwent Turbo Flash Mode CT renal angiography. For group A, a contrast volume of 1 ml/kg and for group B at 0.5 ml/kg was administered. Image Quality was evaluated objectively by calculating CNR and SNR and subjectively by a 5-point scale. Radiation Dose analysis was done by noting CTDIvol and DLP on the scanner system and calculating effective radiation dose (ED).ResultsThe subjective image quality scores for the Turbo Flash group were comparable with the DE group in qualitative image analysis. Additionally, in the Turbo Flash group, there was a reduction in contrast media and effective radiation dose by 47.5% and 32.7%, respectively. Nevertheless, mean attenuation of the abdominal arteries, CNR, SNR, and Noise (S.D) showed statistical significance between the two groups (p value < 0.01).ConclusionsTo our knowledge, no previous study compared Turboflash mode with DE protocol in CT renal angiography in a donor group of patients. Turbo Flash CT is an excellent modality that is faster and has an added advantage of decreased radiation dose and contrast media volume reduction, which can be recommended for screening of voluntary kidney donors but needs further clinical studies, validation, and standardization with tailored protocols.

Recommendations for living donor kidney transplantation

This Guide for Living Donor Kidney Transplantation (LDKT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this Guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current KT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDKT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This Guide does not forget that LDKT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDKT programmes when evaluating potential donors.Finally, this Guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

Evaluation of renal vasculature and its variants by CT angiography

Background: Kidneys are a pair of retroperitoneal organs supplied by a single renal artery and vein. However, the classic illustration of the renal vasculature, formed by one renal artery and one renal vein, occurs in ≤25% of cases. MDCT angiography is presently the most preferred investigation for assessing prospective renal donors. Aims and Objectives: This study aims to familiarize urologists with the variations found in the renal vascular system, emphasizing prevalence, the adequate, appropriate terms, and the clinical and surgical implications involved. Materials and Methods: A cross-sectional study in 50 patients clinically indicated to undergo CT Renal angiographic study over 2 years is included in the study. This study was carried out to look for any anatomical variants in renal vasculature. CT examination was performed on a multidetector 16 slice CT Siemens scanner in the department of radiodiagnosis. Once conventional CT is done, the data obtained can produce 3D post-processing images that simulate conventional angiograms. Results: Out of 50 patients, single renal arteries are present in 27, and multiple renal arteries are present in 23 patients. Out of 27 patients with single renal arteries, 22.2 % has perihilar arterial branching. The most common variant was accessory renal arteries, which are found in 56% of individuals, followed by aberrant renal arteries found in 30% of individuals. Double renal arteries are found in 8.7% and triple renal arteries in 4.3% of cases. Out of 50 patients, 48 patients have a single renal vein, whereas two patients have supernumerary veins. The present study found right renal vein duplication in only 2% of patients. Conclusion: Renal arteries and veins show numerous variations in their origin sites, numbers, course, and division patterns. These variants exist in the population with high prevalence and are thus crucial in preoperative and intra-operative analysis for better prognosis and reduced complications. Preoperative CT evaluation of renal vasculature using MDCT angiography helps depict the presence or absence of renal arterial and venous variants.

Use of CT-based renal volumetry for the measurement of split renal function: a split glomerular filtration rate prediction model based on unilateral renal volume parameters

To develop a split glomerular filtration rate (sGFR) prediction model based on unilateral renal volume parameters using three-dimensional (3D) computed tomography (CT) volumetry. Clinical data (age, sex, height, weight, serum creatinine level [sCr], and sGFR measured by 99mTc-diethylene triamine pentaacetic acid nuclear renal scintigraphy with the double plasma sample method) of 67 healthy renal donors and 111 patients with hydronephrosis admitted from April 2016 to September 2021 were analysed. The split renal parenchymal volume (sRPV) and split renal calyces and pelvis volume (sRCPV) of 67 unilateral donor left kidneys and 111 hydronephrotic kidneys were measured. Statistical analysis of these parameters was performed to develop and validate the sGFR prediction model. sRPV (p<0.001), sRCPV (p=0.012), age (p=0.015), serum creatinine level (p=0.004), and weight (p=0.006) were significantly associated with the measured sGFR and were included in the sGFR prediction formula, which was constructed as: 68.710+0.093×sRPV-0.041×sRCPV-0.228×W-0.219×A-14.432×sCr (r2=0.416; where A is age, W is weight). The paired difference of internal validation between the measured sGFR (42.34±13.71 ml/min/1.73 m2) and the sGFR estimated by the prediction model (41.46±8.99 ml/min/1.73 m2) was 0.879±11.475 ml/min/1.73 m2 (p=0.492) with a 95% confidence interval of the mean difference of ±2.54 ml/min/1.73 m2. The proposed model based on sRPV and sRCPV parameters could be used for estimating split renal function of healthy renal donors and patients with hydronephrosis to some extent. Further studies are required to evaluate and rectify the model.

Human Leukocyte Antigen-A, B, and DRB1 Diversity in Renal Transplant Patients and Donors

Background: The understanding of transplant acceptance or rejection derives directly from knowing human leukocyte antigen (HLA) involved in the immune response. The HLA of the major histocompatibility complex contains a numerous family of genes located on the short arm of the chromosome number 6 and divided majorly into two classes, Class I (HLA-A, B, and C) and Class II (HLA-DR, DQ, and DP). The detection and detailed information of these histocompatibility genes are essential for the better outcome of organ transplants. Aims and Objectives: The aim of the present study is to analyze the frequencies of HLA-A, B, and DRB1 in chronic kidney disease (CKD) patients and their prospective donors as well as to see the prevalence of heterogenicity. Materials and Methods: A total of 264 patients diagnosed with CKD and 333 potential donors were studied retrospectively in the present study. All these cases were analyzed for HLA-A, B, and DRB1 loci typing by PCR-SSOP method based on the Luminex platform. Results: We identified 15 different alleles of HLA-A, 29 of HLA-B, and 13 of HLA-DRB1 amongst studied samples. Out of these identified HLA alleles, HLA-A*02, HLA-B*35, and HLA-DRB1*15 were more frequent as compared to others. The results showed significant heterogenicity in the identified HLA-A, B, and DRB1alleles. Conclusion: The result highlights the diversity of HLA-A, B, and DRB1 alleles and is valuable as a reference for organ transplantations. Further, these findings can also guide in better donor selection and hence improved transplant outcome. In addition, this information could be a starting point for the development of an indigenous transplant assay kit.

Outcomes of Everolimus Plus Standard-Dose Tacrolimus Immunosuppression in De Novo Kidney Transplant: A Retrospective, Single-Center Study of 225 Transplants.

In this study, our aim was to compare the outcomes of everolimus versus mycophenolate mofetil plus standard-dose tacrolimus immunosuppression in patients who received de novo kidney transplant at our center in Fukuoka, Japan. In this retrospective, observational, single-center, inverse probability of treatment weighting analysis study, 225 recipients who underwent kidney transplant at our center between January 2013 and December 2018 were included. The variables considered were recipient age/sex, duration of dialysis, cytomegalovirus mismatch (seronegative recipient and seropositive donor), cause of end-stage renal disease, donor age/sex, and number of HLA mismatches. Our analyses included 85 transplant recipients in the everolimus group and 141 transplant recipients in the mycophenolate mofetil group (n = 226 overall). There were no significant differences between the groups at 1 year for incidence of patient death and allograft loss, biopsy-proven acute rejection, BK virus-associated nephropathy, surgical complications, delayed graft function, and posttransplant diabetes mellitus. Incidence of cytomegalovirus infection and estimated glomerular filtration rate were significantly lower in the everolimus group than in the mycophenolate mofetil group. Posttransplant triglyceride and low-density lipoprotein were higher in the everolimus group than in the mycophenolate mofetil group. Multivariate ordered logistic analysis showed that older donor age and an acute rejection episode, but not induction with everolimus or mean tacrolimus trough concentration throughoutthe firstpostoperative year,were significant risk factors for severity of interstitial fibrosis/tubular atrophy at the 1-year protocol biopsy (P = .004 and P < .001,respectively). Short-term outcomes with everolimus plus standard-dose tacrolimus in recipients of de novo kidney transplant were comparable to those with mycophenolate mofetil plus standard-dose tacrolimus.

Recomendaciones para el trasplante renal de donante vivo

This guide for living donor renal transplantation (LDRT) has been prepared with the sponsorship of the Spanish Society of Nephrology (SEN), the Spanish Transplant Society (SET), and the Spanish National Transplant Organization (ONT). It updates evidence to offer the best chronic renal failure treatment when a potential living donor is available. The core aim of this guide is to supply clinicians who evaluate living donors and transplant recipients with the best decision-making tools, to optimise their outcomes.Moreover, the role of living donors in the current RT context should recover the level of importance it had until recently. To this end the new forms of incompatible HLA and/or ABO donation, as well as the paired donation which is possible in several hospitals with experience in LDRT, offer additional ways to treat renal patients with an incompatible donor.Good results in terms of patient and graft survival have expanded the range of circumstances under which living renal donors are accepted. Older donors are now accepted, as are others with factors that affect the decision, such as a borderline clinical history or alterations, which when evaluated may lead to an additional number of transplantations.This guide does not forget that LDRT may lead to risk for the donor. Pre-donation evaluation has to centre on the problems which may arise over the short or long-term, and these have to be described to the potential donor so that they are able to take them into account. Experience over recent years has led to progress in risk analysis, to protect donors’ health. This aspect always has to be taken into account by LDRT programmes when evaluating potential donors.Finally, this guide has been designed to aid decision-making, with recommendations and suggestions when uncertainties arise in pre-donation studies. Its overarching aim is to ensure that informed consent is based on high quality studies and information supplied to donors and recipients, offering the strongest possible guarantees.

Impact of the kidney transplantation on renalase and blood pressure levels in renal transplant donors and recipients

Introduction and objectivesPrevalence of hypertension increases as glomerular filtration rate (GFR) declines. Renalase metabolizes catecholamines and have an important role in blood pressure (BP) regulation. The purpose of the study was to evaluate the effect of kidney transplantation on renalase levels and BP in kidney donors and recipients. Materials and methodsTwenty kidney transplant recipients and their donors were included in the study. Serum renalase levels and ambulatory BP values were measured in both donors and recipients before and after transplantation. Factor associated with change in renalase and BP levels were also evaluated. ResultsIn donors; mean GFR and hemoglobin levels decreased while night-time systolic blood pressure (SBP) and diastolic blood pressure (DBP) levels and serum renalase levels increased simultaneously after nephrectomy. Day-time SBP and DBP levels did not changed and the night/day ratio of mean arterial pressure (MAP) increased significantly. In recipients, mean GFR increased, while mean serum renalase levels, creatinine and BP levels decreased after transplantation. Correlation analysis revealed that changes in MAP correlated with alteration in serum renalase levels and GFR. ConclusionsAfter transplantation, serum renalase levels increased in donors and decreased in recipients. The renalase levels are associated with change in MAP and circadian rhythm of BP in donors and recipients.

283 Creating an ERAS for Living Donors for Renal Transplant

Abstract Aim To design and facilitate an enhanced recovery after surgery (ERAS) protocol for the Wessex Kidney Centre (WKC) for live donors for renal transplants. This audit focussed on the post-operative analgesia guidelines and average length of hospital stay post the ERAS protocol implementation. Method An enhanced recovery after surgery (ERAS) protocol was created for renal living donors. The protocol incorporated pre, peri and post-operative guidelines to optimise patient care. The protocol was based on a survey sent to all transplant units in the UK regarding their own pathways for live donors(13/23 units responded). The ERAS protocol was then trialled on all live donors throughout 2020 and into 2021 at WKC. For this audit, data was collected on length of stay, analgesia used post-operatively and the VAS scores recorded by patients to grade their pain levels. Results There were a total of 11 renal live donors from September 2020 to January 2021 during which data was collected on all donors. National average length of stay for live donors is 3.9 days. Post ERAS, the average length of stay at WKC is 2.1 days, reduced from an average of 6 days pre-protocol. There was a minimal change in VAS score at 6 hours post-operatively: 3.9 (pre-ERAS average 4.2). However, at 24 hours post-operatively, average VAS score was 2.6 (pre-ERAS average 3.7). Conclusions The introduction of a specific ERAS protocol for live donors for renal transplant notably improved the average post-operative pain scores and reduced the average length of stay to below the national average.