Outcomes of kidney donors with pre‐ and post‐donation kidney stones

Abstract

Roughly 25% of US transplant centers exclude donor candidates with kidney stones fearing future obstructive consequences and the possible association between stones and CKD. We compared the development of hypertension, proteinuria, and reduced eGFR in 227 kidney donors with kidney stones to 908 propensity score‐matched donor controls without kidney stones using data from The Renal and Lung Donor Evaluation (RELIVE) Study which studied intermediate and long‐term outcomes of 8922 donors who donated between 1963 and 2007. 200 donors had kidney stones prior to donation, 21 had post‐donation stones, and 6 had pre‐ and post‐donation stones. Donors with stones were older, more likely to be Caucasian, less likely to be related to the recipient and had a higher fasting glucose. After 16.5 ± 10.9 years (range 0–44 years) from donation to study close, no ESKD occurred in donors with stones. The multivariable risks of hypertension, proteinuria, and reduced GFR were similar in donors with and without kidney stones. We could not demonstrate an association between stones and adverse renal outcomes in kidney donors, and the occurrence of post‐donation stones was distinctly rare. These data may provide a rationale for possibly a wider acceptance of donor candidates with low kidney stones burden.

Clinical and Kidney Structural Characteristics of Living Kidney Donors With Nephrolithiasis and Their Long-term Outcomes

“…However, it lacked granular data on stone formers (SFs) (symptomatic versus asymptomatic), metabolic evaluation in SF, and other potential risk factors for stone recurrence. 15 This data would help guide clinicians in providing better risk assessments for donors with stones on potential long-term complications.…”

Incidence of Kidney Stones in Kidney Transplant Recipients

“…Interestingly, struvite stones, also known as "infection stones," exhibit a higher prevalence among kidney transplant recipients (20%) compared to the general population (10%-15%). This disparity underscores the importance of recognizing the association between struvite stones and urea-splitting bacterial infections (Murad et al, 2021). Given the distinct treatment approach required for struvite stones, emphasizing the removal of all stone fragments and employing antibiotics, this insight holds significance for future research endeavors aimed at preventing and managing kidney stones post-kidney transplantation (Bessede et al, 2021;Tatapudi et al, 2020).…”

Throwing stones: kidney stone incidence in living kidney donor candidates with increased metabolic risk

“…The clinical impact of kidney stones in a solitary kidney can be profound, leading to acute or chronic kidney disease. With this in mind, when evaluating potential kidney donors, approximately 25% of US transplant centers exclude living donor candidates with kidney stones [ 1 , 2 ]. This practice may be unnecessarily eliminating viable donor candidates.…”

“…Prior studies have noted an overall low incidence of post-donation kidney stones, even in donors with history of stones, and no increased risk of hospital encounters, hypertension, proteinuria, or reduced kidney function due to kidney stones [ 2 , 3 ]. The limited published data assessing long-term stone risk after donation has also been reassuring [ 4 , 5 ].…”