Expanding the Donor Pool

O’Brien, Benjamin; Mastoridis, Sotiris; Sabharwal, Atika; Hakim, Nadey; Taube, David; Papalois, Vassilios

doi:10.1097/tp.0b013e31824ef1ae

Cited by 43 publications

(17 citation statements)

References 29 publications

(37 reference statements)

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“…Early and careful assessment of fitness for transplantation is required to facilitate appropriate transplant listing in the elderly. In addition, given the scarcity of donor organs, living donation should be promoted and can be both feasible and successful [69]. …”

Section: Transplantationmentioning

confidence: 99%

Optimising Treatment of End-Stage Renal Disease in the Elderly

Power¹,

Brown²

2014

Nephron Clin Pract

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The features of ageing complicate the management of end-stage renal disease. These complicate all dialysis modalities and will greatly affect the ability to cope with interventional treatments and quality of life. The presence of other illnesses and comorbidity associated with kidney disease mean that many patients have a poor prognosis. It is therefore important to consider the impact of dialysis on lifestyle and whether survival will actually be improved for frail older patients. This review article considers how haemodialysis and peritoneal dialysis can be adjusted for older patients, and, in particular, how the use of assistance makes peritoneal dialysis more feasible. Most importantly, older patients should be given realistic information about their prognosis and how they can cope with different treatment options, and then they should be involved in the decisions about their management.

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Section: Transplantationmentioning

confidence: 99%

Optimising Treatment of End-Stage Renal Disease in the Elderly

Power¹,

Brown²

2014

Nephron Clin Pract

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“…Whether a donor with pre-existing and treated hypertension can be accepted for donation must be considered carefully. One single center study with a low number of older and obese donors demonstrated worse renal function compared to non-obese donors [ 38 ]. Especially older donors seem to have an increased obesity-associated risk for hypertension, which cannot be attributed to nephrectomy alone [ 39 , 40 ].…”

Section: Discussionmentioning

confidence: 99%

Investigation of the physical and psychosocial outcomes after living kidney donation - a multicenter cohort study (SoLKiD - Safety of Living Kidney Donors)

et al. 2018

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BackgroundOver the last years, living kidney donation (LKD) has been established for patients with endstage renal failure as an alternative to post mortem donation, which is limited by organ scarcity and long lasting waiting periods. From an ethical perspective, the increase in LKD requires that donors’ physical, psychological, and social harm has to be minimized as much as possible and the risk should not exceed the generally expected consequences of nephrectomy. Despite of numerous, mainly retrospective studies about the postoperative outcome of LKD over the last years from different countries, it becomes apparent that there is a lack of comprehensive prospective multicenter research in this field worldwide. Therefore, the main aim of the study is to examine the physical and psychosocial outcome of living kidney donors in a prospective design before and after transplantation in an interdisciplinary approach (surgery, nephrology, psychosocial medicine).Methods/designThe goal of the study is to investigate such aspects as the impact of gender- and age-specific factors on LKD outcome, donor outcome in correlation to the health status of the recipient, the medical and psychosocial risk of a healthy subject undergoing the LKD procedure. The study is carried out as a nationwide multicenter study. All adult living kidney donors with sufficient knowledge in the German, Russian, or Turkish language, informed consent, and place of residence in Germany are included. In a naturalistic design (cohort study), clinical data and self-report measures (questionnaires) of 320 donors are collected before and 8 weeks, 6 and 12 months after donation. Primary outcome parameters are the kidney function (estimated GFR) and the quality of life (SF-36) of the donor. Secondary outcome parameters are data about physical (e.g., wound healing, blood pressure) and psychosocial (fatigue, depression, anxiety, somatization) outcome after donation.DiscussionPrevious studies on the postoperative outcome of living kidney donors have methodological limitations and/or were carried out in countries with different healthcare systems, e.g. United States, Norway, Canada, United Kingdom. Thus, results cannot be generalized and are not particularly applicable to the risks of mainly caucasian living kidney donors in the German healthcare system. The study design overcomes these disadvantages in that it provides a prospective multicenter design.Trial registrationGerman Clinical Trials Register DRKS00006552 (22 September 2014).

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“…O'Brien et al [9] performed a cross sectional study on 383 living donors stratified into groups according to age (<65 years, >65 years) and BMI in a single centre with followup of over 5 years and showed no significant differences in operative parameters such as operative time and estimated blood loss between groups. Although rates of early postoperative complications were not significantly different, subgroup analysis showed a higher incidence of respiratory complications at the extremes of obesity (body mass index ≥ 40 kg/m²).…”

Section: Outcome Of Transplantation From Elderly Living Donorsmentioning

confidence: 99%

“…Kidneys from deceased older donors are more likely to be transplanted into older recipients, and this may potentially confound the impact of donor age on outcome [8]. Acceptance of elderly living donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications [9]. Such a risk to a donor whose benefit is at best psychological may be difficult to justify, as it may stretch the “first do no harm principle” [5–8].…”

Section: Introductionmentioning

confidence: 99%

Renal Transplantation from Elderly Living Donors

Akoh

Thiyagarajan

2013

Journal of Transplantation

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Acceptance of elderly living kidney donors remains controversial due to the higher incidence of comorbidity and greater risk of postoperative complications. This is a review of publications in the English language between 2000 and 2013 about renal transplantation from elderly living donors to determine trends and effects of donation, and the outcomes of such transplantation. The last decade witnessed a 50% increase in living kidney donor transplants, with a disproportionate increase in donors >60 years. There is no accelerated loss of kidney function following donation, and the incidence of established renal failure (ERF) and hypertension among donors is similar to that of the general population. The overall incidence of ERF in living donors is about 0.134 per 1000 years. Elderly donors require rigorous assessment and should have a predicted glomerular filtration rate of at least 37.5 mL/min/1.73 m2 at the age of 80. Though elderly donors had lower glomerular filtration rate before donation, proportionate decline after donation was similar in both young and elderly groups. The risks of delayed graft function, acute rejection, and graft failure in transplants from living donors >65 years are significantly higher than transplants from younger donors. A multicentred, long-term, and prospective database addressing the outcomes of kidneys from elderly living donors is recommended.

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Expanding the Donor Pool

Cited by 43 publications

References 29 publications

Optimising Treatment of End-Stage Renal Disease in the Elderly

Optimising Treatment of End-Stage Renal Disease in the Elderly

Investigation of the physical and psychosocial outcomes after living kidney donation - a multicenter cohort study (SoLKiD - Safety of Living Kidney Donors)

Renal Transplantation from Elderly Living Donors

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