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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2010  |  Volume : 21  |  Issue : 5  |  Page : 967-970
Profile of living related kidney donors: A single center experience


Nephrology and Hemodialysis Department, Ibn Rochd Hospital Center, Morocco

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Date of Web Publication31-Aug-2010
 

   Abstract 

The living related donor still represents the unique source for renal transplantation in Morocco. Since 1986, 127 living related potential donors have been evaluated and 100 patients have been transplanted at the Ibn Rochd UHC in Casablanca. We retrospectively studied the potential donors and determined their profile and the exclusion criteria. The mean age at the time of donation was 37 +/- 11 years (range 18-66 years) and 60% of donors were women. The predominant sources of donors were sisters, brothers and mothers of recipients in 34%, 31% and 24% respectively. Forty three percent of them were married, 20% housewives and 17% unemployed. In addition, 37% were illiterate, 45% school graduates, and 18% university graduates. Donors and recipients were incom≠plete HLA match in 72.7%, identical in 19% and different in 8.3%. The cross matching test was negative in all cases. The mean plasma creatinine was 0.8 ± 0.1 mg/dL with mean creatinine clearance of 103.16 ± 18.18 mL/min.

How to cite this article:
Hajji S, Cheddadi K, Medkouri G, Zamd M, Hachim K, Benghanem G M, Ramdani B. Profile of living related kidney donors: A single center experience. Saudi J Kidney Dis Transpl 2010;21:967-70

How to cite this URL:
Hajji S, Cheddadi K, Medkouri G, Zamd M, Hachim K, Benghanem G M, Ramdani B. Profile of living related kidney donors: A single center experience. Saudi J Kidney Dis Transpl [serial online] 2010 [cited 2019 Dec 16];21:967-70. Available from: http://www.sjkdt.org/text.asp?2010/21/5/967/68908

   Introduction Top


Kidney transplantation is the best treatment for patients with end-stage renal disease because it significantly prolongs survival, decreases mor≠bidity, and improves the quality of life. [1],[2],[3],[4],[5] In Morocco, the living donor still represents the unique source for renal transplantation because of the absence of cadaveric transplantation pro≠gram. The transplant program was started in February 1986 at the Ibn Rochd UHC in Casa≠blanca and 100 patients have been transplanted since then till June 2007, all from living related donors. The purpose of this study is to analyze the profile of donors and to determine the inclusion and exclusion criteria.


   Materials and Methods Top


Between February 1986 and June 2007, a total of 100 living donor nephrectomies were per≠formed at the Ibn Rochd UHC in Casablanca [Figure 1]. We undertook a retrospective study of all the donors. We determined their demo≠graphic, clinical and immunologic characters. Donors operated in other countries were ex≠cluded from study.
Figure 1 :Number of living related donor grafts, 1986 - 2007.

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Before being selected as a living donor, care≠ful information was provided to the potential donors. Pre-transplant donor assessment consis-ted of an extensive medical examination, inclu≠ding imaging techniques to visualize kidney func≠tion and anatomy. ABO blood group compati≠bility and a negative cross-match were a pre≠liminary for donors.


   Results Top


A total of 100 living related transplants were performed between February 1986 and June 2007. Out of 127 potential donors who pre≠sented for transplantation, 27 (21.25 %) were not accepted, the reasons are listed in [Table 1].
Table 1 :Exclusion criteria in our series (n=27).

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Among the 100 accepted candidates, there were 60 women and 40 men. The mean age at the time of donation was 37 ± 11 years (range 18-66 years). 21% were older than 50 years of age and four of them were older than 60 years [Figure 2]. The predominant sources of donors were sisters, brothers and mothers of recipients in 34%, 31% and 24% respectively. Forty three percent of them were married, 20% housewives and 17% unemployed. In addition, 37% were illiterate, 45% school graduates, and 18% uni≠versity graduates.
Figure 2 :Distribution of donors by age.

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The most common blood groups were O (61%) and A (31%). Donors and recipients were one haplotype HLA match in 72.7%, identical in 19% and different in 8.3%. The cross matching test was negative in all cases .The clinical evaluation showed: antecedent allergy (n=8), fami≠lial history of diabetes (n=5). One donor aged 50 years old had mild arterial hypertension with normal renal function without proteinuria or microalbuminuria that was controlled by mono≠therapy and another donor had proteinuria of 260 mg/day with a normal renal biopsy. The mean plasma creatinine was 0.8 ± 0.1 mg/dL (range 0.64-1.23mg/dL) with mean creatinine clearance of 103.16 ± 18.18 mL/min (range 81.21 - 135.80 mL/min).


   Discussion Top


Living donation is the unique surgery to im≠prove the life of someone else. There is a po≠tential psychological benefit for the donor rela≠ted to the altruistic act of giving even if signi≠ficant problems may occur among donors after a failed transplantation. Kidney donation has been extensively studied and poses an extremely low risk. Mortality in the peri-operative period is estimated to be 0.03% and severe postoperative complications, such as major hemorrhage and venous thromboembolism, between 0.3 and 1%. [1],[2],[3] Significant proteinuria (> 1 g/day) has been reported in 3% of the donors. [3],[4],[5] Deve≠lopment of kidney failure following donation is uncommon but represents a growing list of subjects since it was first reported in 2002. [6] Nephrectomy is associated with a high rate of hypertension among predisposed donors with isolated medical abnormalities such as hyper≠tension, an increased body mass index (BMI), dyslipidemia, and stone disease. [7] An international forum was convened in Amsterdam, in 2004, to develop an international standard of care for the live donor. [8] Forum participants agreed that be≠fore donation, the live kidney donor must re≠ceive a complete medical and psychosocial eva≠luation, receive appropriate informed consent, and be capable of understanding the informa≠tion presented in that process to make a vo≠luntary decision. [9] Besides absolute contraindi≠cations related to donor renal or extra renal con≠dition, the main selection criteria are glomerular filtration rate (GFR) > 80 mL/min, proteinuria < 0.30 g/day, a body mass index < 35 kg/m2, absence of hypertension, cardiovascular disease, hematuria of renal origin or overt diabetes. Caution is recommended in donors with risk factors for diabetes, a body mass index > 30 kg/m 2 , having a history of renal stones of meta≠bolic origin and tending to recur. [10] In reviewing the available literature, approximately 30% of potential donors who present for transplantation are not accepted. [11] In our series, 21.25% of po≠tential donors were excluded.

In our series, there was a higher incidence of females as compared to males, who were wil≠ling for donation. This pattern is similar to what has been observed in the majority of centers, with more male recipients undergoing live donor transplantation. There are many potential reasons for this donor gender disparity: finan≠cial reasons, medical and immunological contra≠indications, higher incidence of end-stage renal disease in men and fewer men available to wil≠lingly donate. [12],[13],[14]

The mean age of our donors was 37 ± 11 years (range 18-66 years). Twenty-one percent were at least 50 years old, four of them were older than 60 years. The limits of donor age vary among different countries, including centers that do not have a fixed upper age limit. As the waiting list of patients with end-stage renal disease grows continuously, donors aged > 60 years are now accepted for living kidney trans≠plantation in certain transplant centers, however this may have an adverse impact on the long term outcome. [15] Neipp et al compared results following living kidney transplantation from donors :5 50 and > 50 years. [16] Eight years after transplantation patient and graft survival were comparable for both groups. [16]

In conclusion, our experience with pattern of living related donation has been similar to other centers. With the increasing number of dona≠tions needed for chronic kidney disease patients other avenues such as cadaveric renal trans≠plantation would also be explored in Morroco.

 
   References Top

1.Najarian JS, Chavers BM, McHugh LE, et al. 20 years or more of follow-up of living kidney donors. Lancet 1992;340:807.  Back to cited text no. 1  [PUBMED]  [FULLTEXT]  
2.Friedman AL, Peters TG, Jones KW, et al. Fatal and nonfatal hemorrhagic complications of living kidney donation. Ann Surg 2006;243: 126.  Back to cited text no. 2  [PUBMED]  [FULLTEXT]  
3.Hourmant M. Le devenir du donneur vivant. The outcome of the living donor. Nephrol Therap 2007;191:1-2.  Back to cited text no. 3      
4.Fehrman-Erkholm I, Duner F, Brink B, Tyden G, Elinder CG. No evidence of accelerated loss of kidney function in living kidney donors: results from a cross-sectional follow-up.Transplantation 2001;72:444-9.  Back to cited text no. 4      
5.Garg AX, Muirhead N, Knoll G, et al. Donor Nephrectomy Outcomes Research (DONOR) Network. Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression. Kidney Int 2006;70:1801 (Epub September 27, 2006).  Back to cited text no. 5      
6.Gibney EM, Parikh CR, Garg AX. Age, gender, race, and associations with kidney failure following living kidney donation. Transplant Proc 2008;40:1337-40.  Back to cited text no. 6  [PUBMED]  [FULLTEXT]  
7.Boudville N, Prasad GV, Knoll G, et al. Donor Nephrectomy Outcomes Research (DONOR) Network. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med 2006; 145:185.  Back to cited text no. 7  [PUBMED]  [FULLTEXT]  
8.Delmonico FL. A report of the Amsterdam Forum on the Care of the Live Kidney ddonor: Data and medical guidelines. Transplantation 2005;79(Suppl):S53-66.  Back to cited text no. 8      
9.Davis CL, Delmonico FL. Living-donor kidney transplantation: A review of the current practices for the live donor. J Am Soc Nephrol 2005;16:2098-110.  Back to cited text no. 9  [PUBMED]    
10.Hourmant M. Selection of the living donor. Nephrol Therap 2008;4:63-6.  Back to cited text no. 10      
11.Beekman GM, van Dorp WT, van Es LA, et al. Analysis of donor selection procedure in 139 living related kidney donors and follow-up results for donors and recipients. Nephrol Dial Transplant 1994;9:163-8.  Back to cited text no. 11  [PUBMED]  [FULLTEXT]  
12.Scheper-Hughes N. The tyranny of the gift: Sacrificial violence in living donor transplants. Am J Transplant 2007;7:507-11.  Back to cited text no. 12  [PUBMED]  [FULLTEXT]  
13.Kayler LK, Rasmussen CS, Dykstra DM, et al. Gender imbalance and outcomes in living donor renal transplantation in the United States. Am J Transplant 2003;3:452-8.  Back to cited text no. 13  [PUBMED]  [FULLTEXT]  
14.Behzad Einollahi, MD: Gender imbalance in kidney transplantation: Iran in a global pers≠pective. Gender Med 2008;5:101-5.  Back to cited text no. 14      
15.Prommool S, Jhangri GS, Cockfield SM, Hallo≠ran PF. Time dependency of factors affecting renal allograft survival. J Am Soc Nephrol 2000;11:565.  Back to cited text no. 15      
16.Neipp M, Jackobs S, Jaeger M, et al. Living kidney donors >60 years of age: Is it acceptable for the donor and the recipient? Eur Soc Organ Transplant 2006;19:213-7.  Back to cited text no. 16      

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Correspondence Address:
S Hajji
Rue d'Agadir, N 70, Etage 2, Appartement 9, Casablanca 20140
Morocco
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    Tables

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