Abstract: SA-PO823
Living Kidney Donor Candidates With Nephrolithiasis: Examination of Current Practices
Session Information
- Transplantation: Clinical - Pretransplant Assessment and Living Donors
November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2002 Transplantation: Clinical
Authors
- Howard, Matthew, Mayo Clinic School of Medicine - Scottsdale Campus, Scottsdale, Arizona, United States
- Rule, Andrew D., Mayo Clinic Department of Nephrology and Hypertension, Rochester, Minnesota, United States
- Zhang, Nan, Mayo Clinic Department of Quantitative Health Sciences, Scottsdale, Arizona, United States
- D'Costa, Matthew, Mayo Clinic Department of Nephrology and Hypertension, Rochester, Minnesota, United States
- Khamash, Hasan, Mayo Clinic Department of Nephrology and Hypertension, Scottsdale, Arizona, United States
- Wadei, Hani, Mayo Clinic Department of Nephrology and Hypertension, Jacksonville, Florida, United States
- Porter, Ivan E., Mayo Clinic Department of Nephrology and Hypertension, Jacksonville, Florida, United States
- Jadlowiec, Caroline, Mayo Clinic Department of Transplant Surgery, Phoenix, Arizona, United States
- Keddis, Mira T., Mayo Clinic Department of Nephrology and Hypertension, Scottsdale, Arizona, United States
Background
There are currently no universal standards regarding acceptance policies for potential kidney donors with nephrolithiasis. The objective of this study was to describe the acceptance practices at a large center and factors associated with being denied to donate.
Methods
446 adult potential living kidney donors evaluated between 2000 and 2016 with either a personal history or radiological evidence of nephrolithiasis were included. We assessed whether various clinical characteristics and risk factors for stone recurrence including stone size, stone number, and history of symptomatic stone events affected the selection committee’s final decision.
Results
Mean age was 46.0 years (SD 11.7), 247(55.4%) were female, 391(87.7%) were white. 297 (67%) were approved for donation. Of the 149 who were denied, 75 (50%) were denied specifically due to kidney stones and 74 (50%) were denied for other reasons. When comparing the group that was denied due to kidney stones with the approved group, the number of symptomatic stone events (p=0.01), number of stones present on CT (p<0.001), stone diameter (p<0.001), and bilaterality (p<0.001) were all significantly associated with denial. Donor age, sex, family history of stones, presence of medullary sponge kidney, and history of hematuria were not significant predictors of denial. On multivariate analysis, symptomatic stone event (OR 2.3 (95% CI 1.16, 4.56), p=0.017), bilateral kidney stones (OR 4.39 (95% CI 1.78, 11.7), p=0.002) and diameter of largest stone ≥3mm (OR 5.23 (95% CI 2.86, 9.68), p<0.001) were independent predictors of denial due to kidney stone risk.
Conclusion
Most patients seeking to donate a kidney with either a personal history or radiological evidence of nephrolithiasis were approved. Symptomatic stone events, bilateral stones, and stone size ≥3mm negatively influenced donor candidacy. Future studies to assess risk of stone recurrence and related morbidity among those who were approved and those who were denied will better inform selection committee.