Histopathologic evaluation of living kidney donor candidates by pre‐operative kidney biopsy

Abstract

: A lack of deceased kidney donors in Japan has led to dependence on living donors in as many as 80% of cases. At the same time, indications for living‐donor kidney donation have been expanding in terms of donor medical status as well as HLA matching and ABO compatibility, thus emphasizing the donor shortage. To facilitate final medical decision‐making for living kidney donation, we attempted kidney biopsy in six donor candidates who had problems such as mild diabetes and slight proteinuria. The biopsy specimens showed various degrees of tissue injury ranging from partial glomerular sclerosis to arteriole hyalinization. On the basis of the biopsy findings, kidney donation was subsequently performed in three of the six cases with full informed consent, and not done in the remaining three cases. Longer‐term studies will be needed to clarify the outcome in both the donors and recipients in these cases.

RETRACTED ARTICLE: Hyperechogenic renal parenchyma in potential live related kidney donors: Does it justify exclusion?

“…At the same time, indications for living kidney donation have been expanding in terms of donor medical status, e.g. those with mild diabetes and slight proteinuria, as well as human leukocyte antigen matching and ABO compatibility [8] .…”

Τhe Impact of Pre-Transplant Kidney Biopsy on the Evaluation of Prospective Living Kidney Donors

“…We found that almost half of the potential donors were rejected based on biopsy findings. In the literature, four studies describe rejection rates of 38–60% [ 8 , 9 , 10 , 11 ]. However, in two studies, the biopsy indication was isolated microscopic hematuria [ 8 , 10 ].…”

“…However, in two studies, the biopsy indication was isolated microscopic hematuria [ 8 , 10 ]. In another two studies, the indications were hematuria, borderline proteinuria and prediabetes as well [ 9 , 11 ]. Hassan et al included 45 potential donors with isolated microscopic hematuria and rejected 38% [ 8 ].…”

Analysis of preexisting baseline kidney lesions revealed by biopsy in living kidney donors: relationship with clinical parameters at the time of donation

“…Reflecting the shortage of cadaveric donor organs in Japan, the indications for live kidney donation have been expanding, and now include mild medical abnormalities such as hypertension (6), diabetes and proteinuria. Although, for such prospective marginal donors, we have performed predonation kidney biopsy in order to decide medical suitability (4), it is desirable to do so without having to use invasive methods. Our present study showed that pathological changes in the kidneys of living donors can be predicted to some extent on the basis of predonation clinical parameters, including age, s‐Cr, e‐GFR and presence of hypertension.…”

“…Because the safety of living organ donors is essential, we have been carefully deciding the suitability of living donors, and even performing donor kidney biopsy before donation in marginal cases (4). However, it would be preferable to decide the medical indications for live kidney donation without having to use invasive methods.…”