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Living kidney donation

Jan Galle, Jana Reitlinger
In renal replacement therapy, different methods are available: hemodialysis (HD), peritoneal dialysis (PD), and kidney transplantation (KTx). In addition, variants can be used: HD as a home HD or center HD, PD as a conventional PD or automated (cycler) PD, KTx as a potentially short-term predictable living donation or conventional donor kidney donation. The patient and his familiar or caring environment must be informed accordingly. This means first of all: information about which procedures of kidney replacement therapy are possible and can be offered...
June 2018: Deutsche Medizinische Wochenschrift
Colin M E Halverson, Megan Crowley-Matoka, Lainie Friedman Ross
BACKGROUND: Traditionally, living kidney donors were first-degree relatives due to both greater biological compatibility and concerns about extrafamilial motivation. Because familial relationships often entail distinctive experiences of moral obligation, health-care providers must be attentive to potential undue influences on intrafamilial donor decision-making processes to ensure that decisions are voluntary. METHODS: Qualitative interviews were conducted with 20 individuals who donated kidneys to first-degree relatives and subsequently developed end-stage renal disease themselves...
January 1, 2018: Progress in Transplantation
Jessica M Ruck, Sarah E Van Pilsum Rasmussen, Macey L Henderson, Allan B Massie, Dorry L Segev
BACKGROUND: Efforts are underway to improve living kidney donor (LKD) education, but current LKD concerns and information-gathering preferences have not been ascertained to inform evidence-based resource development. As a result, prior studies have found that donors desire information that is not included in current informed consent and/or educational materials. METHODS: We conducted semi-structured interviews with 50 LKDs who donated at our center to assess (1) concerns about donation that they either had personally before or after donation or heard from family members or friends, (2) information that they had desired before donation, and (3) where they sought information about donation...
June 8, 2018: BMC Nephrology
Walter G Wasser, Geoffrey Boner, Meni Koslowsky, Adi Lazar
BACKGROUND: The 2014 Consensus Conference on Best Practices in Living Kidney Donations recognized live donor kidney transplantation as the best treatment for late-stage kidney disease, yielding superior graft and patient survival, improved quality of life, fewer requirements for dialysis and increased cost-effectiveness compared to deceased donor kidney transplantation. Yet in spite of the excellent results of living kidney donation, the annual number of living kidney donors is declining in many countries, including the United States...
June 7, 2018: BMC Nephrology
Adrianne Frech, Ginny Natale, Don Hayes, Dmitry Tumin
PURPOSE: Living kidney donation is safe and effective, but patients in need of a transplant continue to outnumber donors. Disincentives to living donation include lost income, risk of job loss, perioperative complications, and unreimbursed medical expenses. METHODS: This study uses US registry and follow-up data on living kidney donors from 2013 to 2015 to identify social predictors of return to work across gender following living kidney donation. RESULTS: Using logistic regression, we find that predictors of return to work following living kidney donation differ for women and men...
January 1, 2018: Progress in Transplantation
Jeffrey Veale, Erik L Lum, Nick G Cowan, Melissa Wong, Kelly Skovira, Mauri Armijo, Gabriel Danovitch, Tom Mone
BACKGROUND: Procurement and retransplantation of a previously transplanted kidney reclaims a functioning organ that would otherwise have been discarded. METHODS: Case series of 3 retransplantation cases within the course of 1 calendar year. RESULTS: These cases illustrate how to overcome the immunological, logistical, and technical barriers that have thus far limited the potential of this approach. Within this series we report kidney reuse weeks and years following the original transplantation, as well as the previously undescribed 'living donation of a deceased donor kidney'...
May 29, 2018: Transplantation
Darren Lee, John B Whitlam, Natasha Cook, Amanda M Walker, Matthew A Roberts, Francesco L Ierino, Joshua Y Kausman
Living kidney donors (LKD) for pediatric kidney transplant recipients (KTR) have a heightened motivation to donate for emotional reasons and the clear health benefits to the KTR. We hypothesized that the cohort of LKD for pediatric KTR (LKD-P) includes motivated young parents with a higher lifetime end-stage kidney disease (ESKD) risk compared to adult KTR (LKD-A). Data from the Australia and New Zealand Dialysis and Transplant LKD Registry (2004-2015) was analysed to compare baseline characteristics and pre-donation ESKD risk in LKD-P (n=315) versus LKD-A (n=3448)...
May 30, 2018: Transplant International: Official Journal of the European Society for Organ Transplantation
Quang-Linh Nguyen, Pierre Merville, Lionel Couzi
Background: It is recommended to determine the risks of end-stage renal disease (ESRD) in living donor candidates. The aim of this study was to determine how many candidates would have been cleared for donation according to different thresholds of risks. Methods: Four pre-donation and post-donation risks of ESRD were calculated retrospectively using online tools ( and the calculator of the University of Minnesota for 151 living kidney donors and 27 patients disqualified for living donation based on a glomerular filtration rate (GFR) <80 mL/min/1...
May 28, 2018: Nephrology, Dialysis, Transplantation
Mala Sachdeva
As with the suitability for kidney transplantation for obese recipients, there is no universally accepted guideline for clinicians for obese donors; criteria for acceptance are variable among transplant centers. Obesity is on the rise in the United States and the number of living kidney donors who are obese parallel this national trend. Careful risk assessment and informed consent must be undertaken predonation prior to accepting an obese kidney donor in order to minimize long- and short-term complications...
May 28, 2018: Seminars in Dialysis
James R Rodrigue, Aaron Fleishman, Michaela Carroll, Amy R Evenson, Martha Pavlakis, Didier A Mandelbrot, Prabhakar Baliga, David H Howard, Jesse D Schold
Purpose of review: This paper describes the background, rationale, and design of an NIH-funded, single-center study to test the impact of offering reimbursement for donor lost wages incurred during the post-nephrectomy recovery period on the live donor kidney transplant (LDKT) rate in newly evaluated kidney transplant candidates, to examine whether offering reimbursement for donor lost wages reduces racial disparity in LDKT rates, and to determine whether higher reimbursement amounts lead to higher LDKT rates...
March 2018: Current Transplantation Reports
Macey L Henderson
Purpose of review: Living donor transplantation offers patients with end-stage renal disease faster access to transplant and better survival and quality of life than waiting for a deceased donor or remaining on dialysis. While many people state they would be willing to help someone in need through kidney donation, there are education and communication barriers to donor candidate identification. These barriers might be mitigated by technological innovations, including the use of social media...
March 2018: Current Transplantation Reports
E Giorgakis, A L Singer, S E Khorsandi, A Prachalias
OBJECTIVES: Aim of the study was to assess the effect of economic recession on organ donation and transplantation in Greece. METHODS: Retrospective data (2002-2016) provided by the Hellenic Transplant Organization (HTO), International Registry in Organ Donation and Transplantation, Eurotransplant, Scandiatransplant, National Health Service Blood and Transplant (NHSBT), and United Network of Organ Sharing (UNOS) databases were analyzed. HTO database was divided into the precrisis (2002-2008) and crisis (2009-2016) era...
May 23, 2018: Public Health
Dawn B Larson, Jennifer F Wiseman, David Vock, Danielle M Bergund, Ashley Roman, Hassan Nimer Ibrahim, Arthur J Matas
Many living kidney donors undertake a significant financial burden in order to donate. We studied the association between time to return to work and reported financial burden. Kidney donors, who donated from 2/2005 - through 12/2015 (n=1012) were surveyed 6 months postdonation, and asked about occupation; time to return to work; and financial burden (on a 10-point Likert scale). Of 856 donors working for pay, 629 (73%) responded. After adjusting for donor characteristics, increased length of time to return to work was a significant predictor of financial burden (p<0...
May 25, 2018: American Journal of Transplantation
Komal Kumar, James M Tonascia, Abimereki D Muzaale, Tanjala S Purnell, Shane E Ottmann, Fawaz Al Ammary, Mary G Bowring, Anna Poon, Elizabeth A King, Allan B Massie, Eric K H Chow, Alvin G Thomas, Hao Ying, Marvin Borja, Jonathan M Konel, Macey Henderson, Andrew M Cameron, Jacqueline M Garonzik-Wang, Dorry L Segev
Racial disparities in living donor kidney transplantation (LDKT) persist but the most effective target to eliminate these disparities remains unknown. One potential target could be delays during completion of the live donor evaluation process. We studied racial differences in progression through the evaluation process for 247 African American (AA) and 664 non-AA living donor candidates at our center between January 2011-March 2015. AA candidates were more likely to be obese (38% vs. 22%: p<0.001), biologically-related (66% vs...
May 23, 2018: Clinical Transplantation
Rhiannon D Reed, Deirdre Sawinski, Brittany A Shelton, Paul A MacLennan, Michael Hanaway, Vineeta Kumar, Dustin Long, Robert S Gaston, Meredith L Kilgore, Bruce A Julian, Cora E Lewis, Jayme E Locke
BACKGROUND: Living donor kidney transplantation has declined in the United States since 2004, but the relationship between population characteristics and rate of living donation is unknown. The goal of our study was to use data on general population health and socioeconomic status to investigate the association with living donation. METHODS: This cross-sectional, ecological study used population health and socioeconomic status data from the CDC Behavioral Risk Factor Surveillance System (BRFSS) to investigate the association with living donation...
May 22, 2018: Transplantation
Hans Albin Gritsch
This manuscript reviews the outcomes of a European clinical trial to evaluate the effects of living kidney donation on adrenal function. The study shows that left-sided donor nephrectomy is associated with transiently reduced adrenocortical responsiveness, which returns to baseline after 28 d.
May 17, 2018: European Urology Focus
Carla Burballa, Marta Crespo, Dolores Redondo-Pachón, María José Pérez-Sáez, Carlos Arias-Cabrales, Marisa Mir, Albert Francés, Lluís Fumadó, Lluís Cecchini, Julio Pascual
INTRODUCTION: Kidney transplant donors lose 50% of their renal mass after nephrectomy. The remaining kidney compensates for this loss and it is estimated that 70% of the baseline renal function prior to donation is recovered. Factors associated with post-donation renal compensation are not well understood. METHODS: Retrospective study of 66 consecutive kidney donors (mean age 48.8 years, 74.2% women). We analysed the potential factors associated with the compensatory mechanisms of the remaining kidney by comparing donors according to their renal compensation rate (RCR) (Group A, infra-compensation [<70%]; Group B, normal compensation [>70%])...
May 14, 2018: Nefrología: Publicación Oficial de la Sociedad Española Nefrologia
Evelyn M Tenenbaum
Live kidney donation involves a delicate balance between saving the most lives possible and maintaining a transplant system that is fair to the many thousands of patients on the transplant waiting list. Federal law and regulations require that kidney allocation be equitable, but the pressure to save patients subject to ever-lengthening waiting times for a transplant has been swinging the balance toward optimizing utility at the expense of justice. This article traces the progression of innovations created to make optimum use of a patient's own live donors...
March 2018: American Journal of Law & Medicine
Amit K Mathur, Jiawei Xing, David M Dickinson, Patricia H Warren, Kimberly A Gifford, Barry A Hong, Akinlolu Ojo, Robert M Merion
BACKGROUND: The National Living Donor Assistance Center (NLDAC) enables living donor kidney transplants through financial assistance of living donors, but its return on investment (ROI) through savings on dialysis costs remains unknown. METHODS: We retrospectively reviewed 2012-2015 data from NLDAC, the United States Renal Data System, and the Scientific Registry of Transplant Recipients to construct 1-year, 3-year, and 5-year ROI models based on NLDAC applications and national dialysis and transplant cost data...
May 8, 2018: Clinical Transplantation
Y E Yoon, H H Lee, J C Na, K H Huh, M S Kim, S I Kim, Y S Kim, W K Han
BACKGROUND: Smoking is known to result in a decline in renal allograft function and survival of recipients; however, the effect of smoking on living kidney donors remains unknown. In this study we evaluated the impact of cigarette smoking on renal function of kidney donors. METHODS: Among 1056 donors who underwent nephrectomy, 612 completed the 6-month follow-up protocol and were enrolled in the study. The association of smoking status, including pack-years smoking history, and postoperative renal function was evaluated...
May 2018: Transplantation Proceedings
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