Should Living Kidney Donor Candidates with Impaired Fasting Glucose Donate?

Abstract

SummaryAs the kidney transplant waiting list grows, the willingness of transplant centers to accept complex donors increases. Guidelines for the evaluation of living kidney donors exist but do not provide clear guidance when evaluating the complex donor. Although few transplant centers will approve donor candidates with impaired glucose tolerance and most, if not all, will deny candidates with diabetes, many will approve candidates with impaired fasting glucose (IFG). Furthermore, the demographic of living donors has changed in the past 10 years to increasingly include more nonwhite and Hispanic individuals who are at greater risk for future diabetes and hypertension. IFG may be more of a concern in potential donors whose nonwhite and Hispanic ethnicity already places them at greater risk. We review the definition of diabetes, diabetes prediction tools, and transplant guidelines for donor screening and exclusion as it pertains to impaired glucose metabolism, and additional ethnic and nonethnic factors to consider. We offer an algorithm to aid in evaluation of potential living donors with IFG in which ethnicity, age, and features of the metabolic syndrome play a role in the decision making.

Marginal Donors in Renal Transplantation

“…Impaired glucose tolerance and impaired fasting glucose tolerance are two commonly observed impaired glucose physiologies that can lead to diabetes [30]. In the case of isolated fasting glucose tolerance, the primary problem is hepatic insulin resistance, whereas impaired glucose tolerance is caused by increased peripheral insulin resistance [30].…”

“…In the case of isolated fasting glucose tolerance, the primary problem is hepatic insulin resistance, whereas impaired glucose tolerance is caused by increased peripheral insulin resistance [30]. Living donors with impaired glucose tolerance is accepted as a contraindication for renal transplantation; however, fasting glucose is mostly approved if the 2-hour oral glucose tolerance test results are normal [30].…”

Living Donor Practices in the United States

“…This development suggests that programs may increase their use of HbA1c, rather than OGTT, to define risk of future diabetes, but we are not aware of any data describing such recent changes in practice. A recent review proposes an algorithm to aid in evaluation of potential living donors with impaired fasting glucose in which ethnicity, age, and features of the metabolic syndrome play a role in the decision making (31). …”

Approach to the Pretransplant Evaluation of the Living Kidney Donor

“…This group, termed the “prediabetes” group, is defined as having an A1C of 5.7–6.4%, fasting glucose of 100 mg/dL [5.6 mmol/L] to 125 mg/dL [6.9 mmol/L], or a 2h-OGTT value of 140 mg/dL [7.8 mmol/L] to 199 mg/dL [11.0 mmol/L] [3]. In addition to their increased risk of developing diabetes by 5% to 10% per year [4], being in this group is a risk factor for cardiovascular disease. Furthermore, this group has high associations with obesity, hyperlipidemia, metabolic syndrome, or hypertension.…”