Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

Abstract

Purpose of review: To review an international guideline on the evaluation and care of living kidney donors and provide a commentary on the applicability of the recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors and compared this guideline to the Canadian 2014 Kidney Paired Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of Transplantation and the Canadian Society of Nephrology. Members were selected to have representation from across Canada and in various subspecialties related to living kidney donation, including nephrology, surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol recommendations. Canadian researchers have contributed to much of the evidence on donor evaluation and outcomes used to support the KDIGO Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation outcomes given recent evidence, understanding the limitations of the literature with respect to its generalizability to the Canadian donor population.

Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance

“…Four guidelines and two consensus statements recommended enquiring into previous pregnancy complications during the assessment of a potential LKD 31,32,35,40,41 . Six guidelines recommended informing the potential LKD of the increased risk of post‐donation pregnancy complications 31,33‐37 .…”

“…Six guidelines recommended informing the potential LKD of the increased risk of post‐donation pregnancy complications 31,33‐37 . One consensus statement suggested that alternative donors should be sought for women who had not completed their family and had a history of pre‐eclampsia 40 . The 2017 KDIGO guidelines advised against excluding women solely on their desire to conceive post‐donation and suggested that women with a history of pre‐eclampsia may be suitable donor candidates 35 .…”

“…Table 3 lists the eight clinical practice guidelines, 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 three consensus statements, 39 , 40 , 41 and four expert‐opinion papers, 42 , 43 , 44 , 45 all published between 2010 and 2020.…”

“…Four guidelines and two consensus statements recommended enquiring into previous pregnancy complications during the assessment of a potential LKD. 31 , 32 , 35 , 40 , 41 Six guidelines recommended informing the potential LKD of the increased risk of post‐donation pregnancy complications. 31 , 33 , 34 , 35 , 36 , 37 One consensus statement suggested that alternative donors should be sought for women who had not completed their family and had a history of pre‐eclampsia.…”

“…Table 3 lists the eight clinical practice guidelines, [31][32][33][34][35][36][37][38] three consensus statements, [39][40][41] and four expert-opinion papers, [42][43][44][45] all published between 2010 and 2020. Four guidelines and two consensus statements recommended enquiring into previous pregnancy complications during the assessment of a potential LKD.…”