Lifetime end-stage kidney disease risk estimation in living kidney donor candidates remains a challenge

Lifetime risk of end-stage kidney disease in living donors for paediatric kidney transplant recipients in Australia and New Zealand - a retrospective study

“…This study demonstrates that LKD‐P had significantly lower 15‐year but paradoxically higher lifetime predonation risk of ESKD compared to LKD‐A. The lower 15‐year risk likely reflects the LKD‐P being primarily younger parents with fewer comorbidities, while the longer anticipated life expectancy would explain the consequent higher lifetime ESKD risk . Although the differences were statistically significant, the absolute risk differences were minor.…”

“…The recently published Kidney Disease Improving Global Outcomes (KDIGO) guideline [9] recommends the use of a multiparameter prediction tool such as the one developed by Grams et al [10] to estimate the lifetime predonation risk of ESKD, as well as an acceptance risk threshold of 1.0-1.5% (projecting to a postdonation risk of approximately 5%). However, parents as LKD for paediatric kidney transplant recipients (KTR) are usually younger with anticipated higher lifetime ESKD risk postdonation [11] for whom risk prediction may be imprecise, and risk factors poorly captured [12]. This scenario presents a complex clinical scenario balancing optimal donor well-being, the emotional implications of parent-to-child donation and expected health benefits for the child with ESKD.…”