Living organ donation practices in Europe - results from an online survey

Lennerling, Annette; Lovén, Charlotte; Dor, Frank J. M. F.; Ambagtsheer, Frederike; Duerinckx, Nathalie; Frunza, Mihaela; Pascalev, Assya; Zuidema, Willij C.; Weimar, Willem; Dobbels, Fabienne

doi:10.1111/tri.12012

Cited by 74 publications

(67 citation statements)

References 28 publications

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“…Thus, current practices of pre-transplant living donor evaluations vary considerably among countries and even among transplant centers. 23 Halleck et al conducted a survey among all Eurotransplant centers (7 countries and 61 centers) in 2012. 24 They found that majority of the centers use creatinine clearance (64%) in estimating GFR and radioisotopic techniques (82%) in assessing SFD.…”

Section: Discussionmentioning

confidence: 99%

Live Donor Renal Anatomic Asymmetry and Posttransplant Renal Function

et al. 2015

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Background Relationship between live donor renal anatomic asymmetry and post-transplant recipient function has not been studied extensively. Methods We analyzed 96 live-kidney donors, who had anatomical asymmetry (>10% renal length and/or volume difference calculated from CT angiograms) and their matching recipients. Split function differences (SFD) were quantified with 99mTc-DMSA renography. Implantation biopsies at time-zero were semi-quantitatively scored. A comprehensive model utilizing donor renal volume adjusted to recipient weight (Vol/Wgt), SFD, and biopsy score was used to predict recipient estimated glomerular filtration rate (eGFR) at one-year. Primary analysis consisted of a logistic regression model of outcome (odds of developing eGFR>60ml/min/1.73 m2 at one-year), a linear regression model of outcome (predicting recipient eGFR at one-year, using the CKD-EPI formula), and a Monte Carlo simulation based on the linear regression model (N=10,000 iterations). Results In the study cohort, the mean Vol/Wgt and eGFR at one-year were 2.04 ml/kg and 60.4 ml/min/1.73m2, respectively. Volume and split ratios between two donor kidneys were strongly correlated (r=0.79, p-value<0.001). The biopsy scores among SFD categories (<5%, 5–10%, >10%) were not different (p=0.190). On multivariate models, only Vol/Wgt was significantly associated with higher odds of having eGFR>60ml/min/1.73 m2 (OR=8.94, 95% CI 2.47–32.25, p=0.001) and had a strong discriminatory power in predicting the risk of eGFR<60ml/min/1.73m2 at one-year (ROC curve=0.78, 95% CI 0.68–0.89). Conclusion In the presence of donor renal anatomic asymmetry, Vol/Wgt appears to be a major determinant of recipient renal function at one-year post-transplantation. Renography can be replaced with CT volume calculation in estimating split renal function.

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Section: Discussionmentioning

confidence: 99%

Live Donor Renal Anatomic Asymmetry and Posttransplant Renal Function

et al. 2015

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“…We also strongly advocate for a life-long follow up of live kidney donors to minimize the long-term risks and enable early interventions. [7,45] By performing this survey, we aimed to give the transplant community more insight in their policies and attitudes, hopefully leading to an eventual consensus regarding extended criteria donors, and thereby enlarging the donor pool.…”

Section: Discussionmentioning

confidence: 99%

“…[3,6] Unfortunately, the contra-indications vary greatly between transplant centres worldwide, and even nationally. [7] Transplant professionals have the responsibility to perform individual risk calculations to ensure donor safety. Therefore, the choice to accept a potential donor becomes a rather subjective issue.…”

Section: Introductionmentioning

confidence: 99%

Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation

et al. 2017

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BackgroundThe transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals.MethodsAn online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide.Results331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging.ConclusionsRemarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based.

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“…While more data from longterm follow-up studies are being generated, we also strongly advocate for a life-long follow-up of living kidney donors to minimize the long-term risks and enable early interventions [33,34]. In particular, regular medical surveillance of renal function, proteinuria and blood pressure should be advised.…”

Section: Living Donation From Marginal Donors: An Evolving Conceptmentioning

confidence: 99%

Criteria for Living Donation from Marginal Donors: One, No One, and One Hundred Thousand

Cantarelli¹,

Cravedi²

2019

Nephron

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Context: The increasing need for kidney grafts has led to a progressive expansion in the selection criteria for deceased and living donors (LDs). While concerns regarding the use of organs from suboptimal deceased donors relate to the quality of the graft, donation from “marginal” LDs may pose potential harm to the donor. Subject of Review: Living kidney donation is a safe procedure, but is associated with a small risk of end-stage kidney disease in the long- term. When elderly subjects and those with comorbidities are considered, long-term post-donation data are missing, making decisions regarding donation from these populations challenging. Further, vague guidelines have led to a wide heterogeneity in the criteria for living donation from marginal donors across centers and individuals. A recent survey by Lafranca et al. [PLoS One 2017;12:e0181846] collected information from 331 members (mainly physicians) of the European Society of Transplantation regarding several expanded LD criteria. Median refusal rate for potential expanded criteria (ECD) LDs is 15% and the authors found significant differences across regions in Europe in the acceptance of donors with ECD. Some transplant specialists did also deviate from their own transplant center policy, mainly to consider donors with high body mass index. Second Opinion: The survey by Lafranca et al. [PLoS One 2017;12:e0181846] documents extreme variability in the criteria for marginal LD selection. Many centers are deviating from the few agreed upon guideline criteria and are considering individuals with hypertension and minors for kidney donation. Intriguingly, one-fourth of the surgeons even deviate occasionally from center policy, especially when the issue is donor obesity. By and large, these data indicate that transplant community has a generally open approach toward extension of criteria for living donation, but long-term follow-up studies are needed to draw solid conclusions and guidelines.

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Living organ donation practices in Europe - results from an online survey

Cited by 74 publications

References 28 publications

Live Donor Renal Anatomic Asymmetry and Posttransplant Renal Function

Live Donor Renal Anatomic Asymmetry and Posttransplant Renal Function

Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation

Criteria for Living Donation from Marginal Donors: One, No One, and One Hundred Thousand

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