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Saudi Journal of Kidney Diseases and Transplantation
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LETTER TO THE EDITOR  
Year : 2015  |  Volume : 26  |  Issue : 3  |  Page : 592-593
Social trends in living kidney donors in a single center


Department of Nephrology, La Rabta Hospital, Tunis, Tunisia

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Date of Web Publication20-May-2015
 

How to cite this article:
Fatma LB, Zouaghi K, Rais L, Zannad B, Amri N, Kheder R, Krid M, Smaoui W, Beji S, Moussa FB. Social trends in living kidney donors in a single center. Saudi J Kidney Dis Transpl 2015;26:592-3

How to cite this URL:
Fatma LB, Zouaghi K, Rais L, Zannad B, Amri N, Kheder R, Krid M, Smaoui W, Beji S, Moussa FB. Social trends in living kidney donors in a single center. Saudi J Kidney Dis Transpl [serial online] 2015 [cited 2021 Jun 23];26:592-3. Available from: https://www.sjkdt.org/text.asp?2015/26/3/592/157406
To the Editor,

Kidney transplantation is the best treatment for end-stage renal failure, particularly when it is from living-related donors (LRDs) because of the excellent results. Screening of donor and recipient should be performed well in advance to provide maximum security both for the success of the transplant and for the safety of the donor. However, living-related organ donations are still far fewer than those needed.

In our newly established kidney transplant department, we evaluated the demographic aspects and the social trends of 44 LRDs during a period from November 2010 to August 2012. All donors and recipients underwent clinical evaluation and complete laboratory tests, including renal function tests, liver function tests, blood glucose, lipid profile, calcium and phosphate, complete blood count and the needed immunological tests. In addition, chest radiographs, abdomino-pelvic ultrasound and abdominal computed tomography angiography were also carried out. Other parameters analyzed were age, gender, relationship with donor/recipient and whether the transplant was successful or not. Among those who were not taken up as a donor, the reasons for refusal were noted.

There were 22 women (50%) and 22 men (50%) with a mean age of 42.4 years (range 21-87 years). The relationships with the recipients were siblings in 21 cases (48%), wives in seven cases (16%), parents to a child in 12 cases (27%) and an aunt in four cases (9%); there were also two step-brothers and one cousin. In our study, no donation was performed from children to parents. Of the 44 LRDs, 29 donors (66%) were disqualified and were not selected to donate. The reasons for refusals were identified on the various tests performed and are summarized in [Table 1]. Among the 44 donors, 15 donors (34%) were selected for donation; seven women and eight men with a mean age of 41.8 years (range: 28- 57 years).
Table 1: Causes of refused donors.

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In our study, the percentage of donors disqualified was about 66%, which is high in our report. Some causes of refusals were those with relative contraindications, such as glucose intolerance, mild hypertension, age limit and pregnancy. Diabetes is associated with an increased risk of post-surgical complications and future development of renal failure compared with the general population; it increases the risk of developing diabetic nephropathy after nephrectomy among the donors. [1],[2],[3] However, glucose intolerance is nowadays not an absolute contraindication but only a relative one for kidney donation. Donors who are on monotherapy for hypertension could be accepted for kidney donation if the blood pressure is controlled and if it does not have a detectable effect on the heart, such left ventricular hypertrophy, effects on eyes and surely on the kidney. [4] Blood pressure (BP) should preferably be measured by ambulatory blood pressure monitoring (ABPM). Patients with an average BP ≥140/90 mm Hg by ABPM are generally not acceptable as donors. Patients with easily controlled hypertension who meet other defined criteria (e.g., ≥50 years of age, glomerular filtration rate ≥80 mL/min and urinary albumin excretion <30 mg/day) may represent a lowrisk group for the development of kidney disease after donation and may be accepted as kidney donors. [4] The changing definition of hypertension makes comparison of yesterday's donors with today's donors somewhat difficult. In the past, hypertension was defined as a BP of >150 to 160/90 to 100 mm Hg, whereas today it is defined as a BP of >140/90 mm Hg or on treatment for hypertension. [4]

The most frequently found relationship was that of siblings. The relationship between living donors and their recipients has changed over time. [5] Today, donors are less likely to be blood relatives of the recipient and instead may be from those who have kinship by alliance. [5] It was also the case in our study. In our report, we did not find any donation from a child to his parent. This is probably related to the reluctance of the medical team to take a kidney from a young person to transplant on to a much older person. In fact, we think that children are, most of the time, too young and only planning their life.

Kidney transplantation from LRD offers many benefits to the recipient, but a strict donor selection should be imposed. Exploration as complete as possible is necessary for the donor to detect the slightest reason indicating against the kidney donation process to ensure the success of the graft on one hand and to prevent the safety of the donor on the other hand. In our study, a large number of donors were not selected for kidney donation. Some donors with relative contraindications may be considered for donation to shorten the waiting list.

Conflict of interest: None declared.

 
   References Top

1.
Mandelbrot DA, Pavlakis M, Danovitch GM, et al. The medical evaluation of living kidney donors: A survey of US transplant centers. Am J Transplant 2007;7:2333-43.  Back to cited text no. 1
    
2.
Veerappan I, Neelakantan N, Tamilarasi V, John GT. Medical and non-medical factors that affect voluntary living-related kidney donation: A single-center study. Indian J Nephrol 2011; 21:14-20.  Back to cited text no. 2
[PUBMED]  Medknow Journal  
3.
Baid-Agrawal S, Frei UA. Living donor renal transplantation: Recent developments and perspectives. Nat Clin Pract Nephrol 2007;3: 31-41.  Back to cited text no. 3
    
4.
Kokubo Y, Kamide K. High-normal blood pressure and the risk of cardiovascular disease. Circ J 2009;73:1381-5.  Back to cited text no. 4
    
5.
De Marco M, de Simone G, Roman MJ, et al. Cardiovascular and metabolic predictors of progression of prehypertension into hypertension: The Strong Heart Study. Hypertension 2009;54:974-80.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Lilia Ben Fatma
Department of Nephrology,La Rabta Hospital, Jabbari, 2007, Tunis
Tunisia
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DOI: 10.4103/1319-2442.157406

PMID: 26022035

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