Renal Transplantation From Elderly Living Donors
Jacob A. Akoh
1South West Transplant Centre, Plymouth Hospitals NHS Trust, Derriford Hospital, Plymouth PL6 8DH, UK
Abstract
1. Introduction
Kidney transplantation is the optimum replacement therapy for patients with established renal failure , as it offers better quality of life and improved survival . The demand for renal transplantation has increased due to the growing prevalence of ERF and extension of the criteria for accepting patients onto the waiting list. In response to the increasing need for organs, deceased donor programs and donation after brain death ) are being optimized, and living kidney donation expanded in several countries to include both related and unrelated donation. Further developments include ABO incompatible transplantation, legalised altruistic nondirected living donation, and adoption of paired or more complex exchange of living donor programs. In the last decade in the UK, there has been significant growth in living donor kidney transplantation with 485 transplants in 2005, increasing to 1,055 in 2012 . All these have not succeeded in meeting the demand for renal transplantation, and efforts to provide more donors have included the use of marginal living donors, particularly elderly living donors.
2. Methodology
2.1. Search Strategy
3. Effects of Aging on Kidney Function
4. Criteria for Selection of Living Donors
4.1. Glomerular Filtration Rate
4.2. Hypertension
4.3. Other Medical Comorbidities
5. Trends in Living Donation
6.3. ERF
References
Can You Live With One Kidney
Fortunately, a person really only needs 1 functioning kidney to lead a healthy life. During a living kidney transplant surgery, 1 healthy kidney is removed from the donor to be placed in the transplant recipientleaving 1 healthy kidney intact. That single kidney can work to filter blood and perform all its other functions to help keep the donor healthy over a lifetime.
Do I Need To Do Anything To Prepare For My Egfr Test
Your doctor may have you fast or avoid certain foods for several hours before the test. They will let you know how to prepare.
You may have a blood creatinine test as part of a regular check-up or if your doctor thinks you might have kidney disease. Your doctor will figure out your eGFR using your creatinine blood test result and your age, sex, weight and race.
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Changes In Kidney Function Follow Living Donor Nephrectomy
- Ngan N. LamCorrespondenceCorrespondence: Ngan N. Lam, Health Research Innovation Centre, 3230 Hospital Drive NW, University of Calgary, Calgary, Alberta, Canada, T2N 4Z6.Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, CanadaDepartment of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, CanadaDepartment of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, CanadaDepartment of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Division of Nephrology, University of Calgary, Calgary, Alberta, CanadaDepartment of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Department of Medicine, Division of Nephrology, Western University, London, Ontario, CanadaDepartment of Epidemiology and Biostatistics, Western University, London, Ontario, CanadaInstitute for Clinical Evaluative Sciences , Ontario, Canada
Minimum Advisory Gfr Thresholds For Living Kidney Donation
The evaluation of prospective living kidney donors aims to identify those whom donation would put at an unacceptably high risk of long-term complications, including ESRD. Previous studies have suggested that the risk of ESRD after living kidney donation is not higher than in the general population , but there is a small absolute increased risk . A recent meta-analysis found the relative risk for ESRD was about 9-fold higher in donors compared to non-donors, but the estimated incidence rate was less than 1 case per 1000 person-years . Assessment of GFR in prospective kidney donors is an important factor in determining risk and living kidney donation guidelines have provided threshold GFRs above which the increased risk may generally be considered acceptable. For example, the 2017 KDIGO guideline suggests that a GFR 90 mL/min/1.73m2 is acceptable for donation, while a GFR < 60 mL/min/1.73m2 is not acceptable for donation and a GFR 6089 mL/min/1.73m2 may be acceptable depending on other risk factors .
In our study population of 2974 prospective donors, these GFR thresholds would lead to the exclusion of an additional 5.0% of prospective donors compared to the thresholds in the previous BTS living kidney donation guidelines if adhered to rigidly .
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Study Population And Gfr Reference Ranges
We identified and collected data for 1096 prospective living kidney donors from our three centres who had undergone mGFR between 2007 and 2015. These data were amalgamated with individual-level data from 1878 prospective donors from the 15 other UK renal centres, producing a dataset for 2974 prospective donors from 18 centres. 1284 were male, mean age was 46.3 years , and mean mGFR was 89.8 mL/min/1.73m2 . The cohort included 459 individuals over 60 years of age, 51 individuals over 70 years, and 1 individual over the age of 80 years. Figure shows a scatter plot of mGFR by age. Overall, 78 individuals had a mGFR < 60 mL/min/1.73m2. Forty-eight of the 459 individuals aged over 60 years had a mGFR < 60 mL/min/1.73m2.
Fig. 1
Scatter plot of measured GFR by age in 2974 prospective living kidney donors. GFR, glomerular filtration rate
The means and reference ranges for GFR by age and gender are shown in Table and Fig. . Overall males had a higher mGFR than females . Measured GFR was approximately 100 mL/min/1.73m2 until 35 years of age, following which there was a linear decline. This GFR decline was faster in females compared to males . BSA did not correlate with age for males or females.
Table 1 Age- and gender-specific normal GFR reference ranges based on measured GFRs from 2974 prospective living kidney donorsFig. 2
How To Improve Your Gfr And Kidney Health With Diet Changes
If you’ve been thinking about kidney health and your glomerular filtration rate , you may be wondering if diet can improve it. According to experts, what you do and don’t eat can affect your GFR and kidneys. Here’s a breakdown of how diet plays a role in GFR health.
Your GFR is the best overall indicator of kidney function, according to the National Kidney Foundation .
“We each have two kidneys, and, in a healthy state, each has about 800,000 filtering units called nephrons,” says Chicago-based Holly Kramer, MD, MPH, professor of public health sciences at Loyola University and spokesperson for the NKF.
Your total GFR is the sum of filtration of each one of these filters. In most healthy people, a normal GFR is 90 mL/min/1.73 m2 or higher, per the NKF.
This is a lot of nephrons, and we don’t always need all of them, which is why healthy people can donate a kidney and still have normal kidney function, Dr. Kramer says.
Your doctor can estimate your GFR with a blood test measuring your creatinine level and some other factors such as sex, age, weight and race, according to the National Institute of Diabetes and Digestive and Kidney Diseases .
In people with kidney disease, high blood pressure or poorly controlled diabetes, nephrons can become scarred, Dr. Kramer says.
“To compensate, they work harder, which causes more scarring,” she says. While what’s done is done, eating a healthy diet can help prevent further GFR decline and scarring of nephrons, according to the NKF.
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Estimated Glomerular Filtration Rate Test
Please note: eGFR is an estimate of how well your kidneys are working. The way eGFR is calculated will be changing. Currently the test considers your age, sex and race, among other things. A task force led by the National Kidney Foundation and the American Society of Nephrology is working on recommendations that may remove Black race as a factor in the eGFR calculation. The task force has been seeking the input of kidney disease experts to come up with the best way to make the eGFR test as accurate as possible. American Kidney Fund advised the task force to remove race from the eGFR so there is no bias in testing kidney function. This would help to make sure that every person will receive health care that is fair and of the highest quality. When the NKF-ASN task force makes its recommendations, AKF will promptly review them and then update our educational materials.
Who Can Have A Kidney Transplant
Most people who need a kidney transplant are able to have one, regardless of their age, as long as:
- they’re well enough to withstand the effects of surgery
- the transplant has a relatively good chance of success
- the person is willing to comply with the recommended treatments required after the transplant such as taking immunosuppressant medication and attending regular follow-up appointments
Reasons why it may not be safe or effective to perform a transplant include having an ongoing infection , severe heart disease, cancer that has spread to several places in your body, or AIDS.
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Can My Egfr Change
Your eGFR can change over time and can change based on some other problems, like if you have not been drinking enough water.
As chronic kidney disease gets worse, your eGFR number will go down. If caught early, healthy life changes like following a kidney-friendly eating plan and getting enough exercise may help slow down the progression of CKD and how fast your eGFR changes.
What Processes Do You Have To Go Through To Be A Living Kidney Donor
The decision to donate a kidney is just the first step on a journey that may eventually lead to a kidney transplant operation.
Everyone who wants to donate is asked to go through a number of tests and examinations. These checks are designed to ensure that you are healthy enough to give a kidney, that your kidneys are currently working well and that you are physically and emotionally prepared for the donation. Your safety and well-being is always the priority for the medical teams and you should be aware from the beginning that there may be a number of reasons why you might not be suitable to donate. The tests and checks can take several months , which include medical, surgical and psychological assessments.
In England, Wales and Northern Ireland, no minimum age limit is specified under the Human Tissue Act 2004, but most donors will be over the age of 18 years. In Scotland, the law specifies that the donor has to be over 16. There is no upper age limit, and there have been donors in their 70s and 80s.
Throughout the process, anonymity and confidentiality are necessary, and most altruistic donors never meet the person who receives their donated kidney. It is, however, possible for both parties to contact each other after the transplantation, but only if both parties are willing.
Tests and examinations before the operation
General physical health
Psychological health
Urine tests
Blood tests
Glucose tolerance test
Blood pressure monitoring
Kidney tests
ECG
Chest X-ray
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Rate Of Change In Kidney Function
Mean estimated glomerular filtration rate over time in living kidney donors and matched, healthy nondonor controls .
| Model | A total of 38 living kidney donors did not have serum creatinine measurements beyond the 6 wk following donation, so their matched controls were also excluded from this analysis. | Controls A total of 38 living kidney donors did not have serum creatinine measurements beyond the 6 wk following donation, so their matched controls were also excluded from this analysis. | P value |
|---|---|---|---|
| 6 wk to < 2 yr | +1.06 |
Assessment Of Gfr Range
In the United States, performance of a clearance measurement is required for GFR evaluation. In our experience, it is helpful to interpret clearance measurements in light of eGFR. Despite the well recognized imprecision of eGFR at higher levels, it can provide substantial information to estimate the probability that mGFR is above or below the thresholds for decision-making. For example, the pretest probabilities for mGFR thresholds of interest can be computed using data from National Health and Nutrition Examination Surveys, and the post-test probabilities can be computed using categorical likelihood ratios for eGFRcr using the CKD-EPI equation. Very high post-test probabilities provide reassurance that mGFR is above the threshold, whereas very low post-test probabilities provide reassurance that mGFR is below the threshold. If serum cystatin C is available, eGFRcrcys can be computed, and post-test probabilities for mGFR thresholds can be recomputed by substituting post-test probabilities from eGFRcr as pretest probabilities and substituting categorical likelihood ratios for eGFRcrcys to compute post-test probabilities. A web-based calculator has been developed to compute post-test probabilities for mGFR above or below various threshold probabilities .
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What Happens If You Have Kidney Disease
Kidney disease can be treated. The sooner you know you have kidney disease, the sooner you can get treatment to help delay or prevent kidney failure. Treating kidney disease may also help prevent heart disease.
Treatment goals are to:
- If you smoke, take steps to quit.
- Take medicines the way your provider tells you to.
The Recovery And Aftermath
Recovery from a kidney donation operation can take from two to 12 weeks depending on the persons individual progress.
Traditional open surgery
If the operation was an open nephrectomy, you may be in hospital for five to seven days, but you should be out of bed the day after the operation. Surgeons use either stitches or clips to close the incisions they made during the operation and these will be removed around 10 days after the procedure.
Before you leave hospital, a follow-up clinic appointment will be made, usually for four to six weeks later. The scars from the operation may be sensitive or sore for several weeks, and some numbness around the scar is common. There will be a permanent scar. There may also be twinges or a drawing sensation around the scars for some months, but most people feel back to normal by about 12 weeks after the operation.
Keyhole surgery
If the operation was keyhole surgery, recovery time is shorter and there is usually less pain afterwards. After this type of surgery you will normally need four to six weeks of recovery time at home before resuming your normal activities. Painkillers may be needed for a while, depending on an individuals symptoms. You will be asked to come in for a follow-up appointment four to six weeks after the operation.
Psychological impact
Getting back to normal life
You should return to exercise gradually and gently and build up any exercise routine slowly.
Further reading
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How Do I Find Out My Egfr
You will have a blood test to see how much creatinine is in your blood. Creatinine is a waste product in your blood that comes from your muscles. Healthy kidneys take creatinine out of your blood and send it out of your body through your urine. If your kidneys are not working the way they should, creatinine will build up in your blood.
You will have a blood test to see how much creatinine is in your blood. Creatinine is a waste product in your blood that comes from your muscles. Healthy kidneys take creatinine out of your blood and send it out of your body through your urine. If your kidneys are not working the way they should, creatinine will build up in your blood.
How To Donate Your Kidney
This article was medically reviewed by . Dr. Ziats is an Internal Medicine Physician, Researcher, and Entrepreneur in biotechnology. He received his PhD in Genetics from the University of Cambridge in 2014, and completed his MD shortly thereafter, at Baylor College of Medicine in 2015.There are 14 references cited in this article, which can be found at the bottom of the page. This article has been viewed 36,808 times.
Whether you want to donate a kidney to someone you love or you just want to be a good samaritan, theres a lot you need to know. Donating a kidney can save someone elses life, but it is not without its risks. First, you need to do thorough research to make sure you really want to donate your kidney. Then you must endure a series of medical tests to find out if you are an eligible donor. If you pass all the tests, youre ready to start talking to your doctor about surgery.
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What Is Living Donation
Living donation takes place when a living person donates an organ for transplantation to another person. The living donor can be a family member, such as a parent, child, brother or sister .
Living donation can also come from someone who is emotionally related to the recipient, such as a good friend, spouse or an in-law . Thanks to improved medications, a genetic link between the donor and recipient is no longer required to ensure a successful transplant.
In some cases, living donation may even be from a stranger, which is called anonymous or non-directed donation.
Clinical Investigationchanges In Kidney Function Follow Living Donor Nephrectomy
Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate before cohort entry . The primary outcome was the rate of eGFR change over time . The median age of the cohort was 43 years, 64% women, and the baseline eGFR was 100 mL/min/1.73 m2. Overall, from six weeks onwards, the eGFR increased by +0.35 mL/min/1.73 m2 per year in donors and significantly decreased by -0.85 mL/min/1.73 m2 per year in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was +1.06, +0.64, and -0.06 mL/min/1.73 m2 per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.
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