Saudi Journal of Kidney Diseases and Transplantation

RENAL DATA FROM THE ARAB WORLD
Year
: 2010  |  Volume : 21  |  Issue : 5  |  Page : 967--970

Profile of living related kidney donors: A single center experience


S Hajji, K Cheddadi, G Medkouri, M Zamd, K Hachim, GM Benghanem, B Ramdani 
 Nephrology and Hemodialysis Department, Ibn Rochd Hospital Center, Morocco

Correspondence Address:
S Hajji
Rue d«SQ»Agadir, N 70, Etage 2, Appartement 9, Casablanca 20140
Morocco

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 incom­plete 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;21:967-970


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 2021 Jun 19 ];21:967-970
Available from: https://www.sjkdt.org/text.asp?2010/21/5/967/68908


Full Text

 Introduction



Kidney transplantation is the best treatment for patients with end-stage renal disease because it significantly prolongs survival, decreases mor­bidity, 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 pro­gram. The transplant program was started in February 1986 at the Ibn Rochd UHC in Casa­blanca 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



Between February 1986 and June 2007, a total of 100 living donor nephrectomies were per­formed at the Ibn Rochd UHC in Casablanca [Figure 1]. We undertook a retrospective study of all the donors. We determined their demo­graphic, clinical and immunologic characters. Donors operated in other countries were ex­cluded from study.{Figure 1}

Before being selected as a living donor, care­ful information was provided to the potential donors. Pre-transplant donor assessment consis-ted of an extensive medical examination, inclu­ding imaging techniques to visualize kidney func­tion and anatomy. ABO blood group compati­bility and a negative cross-match were a pre­liminary for donors.

 Results



A total of 100 living related transplants were performed between February 1986 and June 2007. Out of 127 potential donors who pre­sented for transplantation, 27 (21.25 %) were not accepted, the reasons are listed in [Table 1].{Table 1}

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% uni­versity graduates.{Figure 2}

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), fami­lial 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 mono­therapy 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



Living donation is the unique surgery to im­prove the life of someone else. There is a po­tential psychological benefit for the donor rela­ted to the altruistic act of giving even if signi­ficant 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] Deve­lopment 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 hyper­tension, 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 be­fore donation, the live kidney donor must re­ceive a complete medical and psychosocial eva­luation, receive appropriate informed consent, and be capable of understanding the informa­tion presented in that process to make a vo­luntary decision. [9] Besides absolute contraindi­cations related to donor renal or extra renal con­dition, 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 meta­bolic 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 po­tential donors were excluded.

In our series, there was a higher incidence of females as compared to males, who were wil­ling 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: finan­cial reasons, medical and immunological contra­indications, higher incidence of end-stage renal disease in men and fewer men available to wil­lingly 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 trans­plantation 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 dona­tions needed for chronic kidney disease patients other avenues such as cadaveric renal trans­plantation would also be explored in Morroco.

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