Living Donor Kidney Transplantation

Rodrigue, James R.; Kazley, Abby Swanson; Mandelbrot, Didier A.; Hays, Rebecca; Rudow, Dianne LaPointe; Baliga, Prabhakar K.

doi:10.2215/cjn.00700115

Cited by 107 publications

(96 citation statements)

References 73 publications

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“…However, the shortage of available kidneys and plateauing rates of kidney donation 16 has led some centers to reconsider nephrolithiasis as an absolute contradiction. 17 If incidental nephrolithiasis without an associated significant metabolic abnormality becomes widely accepted under extended criteria, it is logical to expect nephrolithiasis to become a less frequent reason of potential donor exclusion in the future.…”

Section: Discussionmentioning

confidence: 99%

Computed tomography identified factors that preclude living kidney donation

Mastrocostas

Chingkoe

Pace

et al. 2018

CUAJ

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Introduction: The purpose of this study was to determine the variety and prevalence of renal and non-renal abnormalities detected on multi-detector computed tomography (MDCT) that precluded patients from donating a kidney. Methods: Institutional review board approval was obtained and the requirement for informed consent was waived. A retrospective, single-centre review of 701 patients (444 female, 257 male; age range 18-86 years; mean age 43.2±11.9 years) that underwent renal donor protocol MDCT was conducted. A systematic review of the CT report, records from multidisciplinary renal transplantation rounds, and electronic medical records was performed to determine which patients were approved or declined as live renal donors. If declined as a donor, CT-identified reasons were categorized as abnormalities of renal vasculature, renal parenchyma, collecting system, or extra-renal. Results: A total of 81 patients were excluded as renal donors on the basis of CT findings. Abnormalities of the collecting system accounted for the most frequent cause of exclusion (n=41), with asymptomatic renal calculi being detected in 39 patients. Complex vascular anatomy and vascular abnormalities resulted in the exclusion of 29 patients. Supernumerary arteries and early arterial branching resulted in the exclusion of 20 patients, while renal vein anomalies leading to exclusion were uncommon (n=2). Abnormalities of renal parenchyma resulted in the exclusion of nine patients. Three patients were diagnosed with autosomal dominant polycystic kidney disease, two patients had renal cell carcinoma, and two patients had areas of cortical scarring. A complex cystic lesion requiring surveillance imaging was encountered in one patient and a large area of renal infarction related to prior adrenalectomy was demonstrated in one patient. Extra-renal abnormalities leading to exclusion were limited to two patients with pulmonary nodules.

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Section: Discussionmentioning

confidence: 99%

Computed tomography identified factors that preclude living kidney donation

Mastrocostas

Chingkoe

Pace

et al. 2018

CUAJ

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“…Clarifying the impact of SES in LDKT will help inform attention to financial support resources within education programs. The AST Consensus Conference also duly recommended that future research must still occur to understand how modifying different possible causes for racial disparities affects pursuit of LDKT among different racial/ethnic minority groups [64••]. For example, past LDKT educational programs targeting Black and/or Hispanic kidney patients have aimed to increase knowledge or address fears by providing improved educational materials and longer educational conversations [37], supporting patients in completing small steps toward LDKT [24], providing individually guided navigation services [40], and assisting patients in obtaining financial resources to address socioeconomic barriers [36].…”

Section: Educating Both Potential Living Donors and Recipientsmentioning

confidence: 99%

Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates

2016

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A promising strategy for increasing living donor kidney transplant (LDKT) rates is improving education about living donation for both prospective kidney transplant recipients and living donors to help overcome the proven knowledge, psychological, and socioeconomic barriers to LDKT. A recent Consensus Conference on Best Practices in Live Kidney Donation recommended that comprehensive LDKT education be made available to patients at all stages of chronic kidney disease (CKD). However, in considering how to implement this recommendation across different healthcare learning environments, the current lack of available guidance regarding how to design, deliver, and measure the efficacy of LDKT education programs is notable. In the current article, we provide an overview of how one behavior change theory, the Transtheoretical Model of Behavior Change, can guide the delivery of LDKT education for patients at various stages of CKD and readiness for LDKT. We also discuss the importance of creating educational programs for both potential kidney transplant recipients and living donors, and identify key priorities for educational research to reduce racial disparities in LDKT and increase LDKT rates.

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“…More recently, studies have shown that trained kidney transplant recipients serving as patient navigators for patients with ESKD within dialysis facilities doubled the number of steps that a patient completed in the transplant process (15) and increased access to living donor transplantation (16), but the effectiveness of a patient navigator program among a historically disadvantaged group of patients with ESKD has not been studied. The kidney transplant community has called for targeted interventions among disadvantaged groups as one approach to eliminate health disparities in transplantation (17)(18)(19)(20)(21)(22)(23); however, to reduce disparities, an intervention must be either more effective among the disparate group or implemented among the disparate group only (17).…”

Section: Introductionmentioning

confidence: 99%

Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population

Basu¹,

Petgrave-Nelson

Smith

et al. 2018

CJASN

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Background and objectives Barriers exist in access to kidney transplantation, where minority and patients with low socioeconomic status are less likely to complete transplant evaluation. The purpose of this study was to examine the effectiveness of a transplant center-based patient navigator in helping patients at high risk of dropping out of the transplant evaluation process access the kidney transplant waiting list.Design, setting, participants & measurements We conducted a randomized, controlled trial of 401 patients (n=196 intervention and n=205 control) referred for kidney transplant evaluation (January 2013 to August 2014; followed through May 2016) at a single center. A trained navigator assisted intervention participants from referral to waitlisting decision to increase waitlisting (primary outcome) and decrease time from referral to waitlisting (secondary outcome). Time-dependent Cox proportional hazards models were used to determine differences in waitlisting between intervention and control patients.Results At study end, waitlisting was not significantly different among intervention (32%) versus control (26%) patients overall (P=0.17), and time from referral to waitlisting was 126 days longer for intervention patients. However, the effectiveness of the navigator varied from early (,500 days from referral) to late ($500 days) followup. Although no difference in waitlisting was observed among intervention (50%) versus control (50%) patients in the early period (hazard ratio, 1.03; 95% confidence interval, 0.69 to 1.53), intervention patients were 3.3 times more likely to be waitlisted after 500 days (75% versus 25%; hazard ratio, 3.31; 95% confidence interval, 1.20 to 9.12). There were no significant differences in intervention versus control patients who started evaluation (85% versus 79%; P=0.11) or completed evaluation (58% versus 51%; P=0.14); however, intervention patients had more living donor inquiries (18% versus 10%; P=0.03).Conclusions A transplant center-based navigator targeting disadvantaged patients improved waitlisting but not until after 500 days of follow-up. However, the absolute effect was relatively small.

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Living Donor Kidney Transplantation

Cited by 107 publications

References 73 publications

Computed tomography identified factors that preclude living kidney donation

Computed tomography identified factors that preclude living kidney donation

Educating Prospective Kidney Transplant Recipients and Living Donors about Living Donation: Practical and Theoretical Recommendations for Increasing Living Donation Rates

Transplant Center Patient Navigator and Access to Transplantation among High-Risk Population

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