Abstract: FR-PO0956
Living Kidney Donation: A Comparative Look at Practices in Italy and the United States (US)
Session Information
- Transplantation: Clinical - Pretransplantation, Living Donation, and Policies
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Transplantation
- 2102 Transplantation: Clinical
Authors
- Ricci, Virginia, University of Piemonte Orientale, Vercelli, Italy
- Guglielmetti, Gabriele, University of Piemonte Orientale, Vercelli, Italy
- Rabb, Hamid, Johns Hopkins University, Baltimore, Maryland, United States
- Cantaluppi, Vincenzo, University of Piemonte Orientale, Vercelli, Italy
- Mejia, Christina Irene, Johns Hopkins University, Baltimore, Maryland, United States
Background
The evaluation and follow-up of living kidney donors (LD) vary around the world. We aim to compare LD practices in Italy and the US using representative transplant centers and determine differences in post-donation outcomes.
Methods
To determine LD evaluation and follow-up practices, we performed a literature review and interview of transplant nephrologists at the University of Piemonte Orientale (UPO) and Johns Hopkins University (JH). We also conducted a comparative retrospective observational study of all LDs at UPO and JH from 2014-2024. We obtained donor age, body mass index (BMI), smoking status, HTN, and pre- and post-donation serum creatinine. We limited our analysis to descriptive statistics.
Results
From 2014-2024, 22% and 21% of all transplants in UPO and JH were from LDs, respectively. Of the 131 LDs at UPO, 68% were female, 16% were current smokers and 23% had HTN. Mean age at donation was 54+10 yrs and mean BMI was 25.2+ 4 kg/m2. Of the 510 LDs from JH, 62% were female, 6% were current smokers and 3% had HTN. Mean age was 46+13 yrs and mean BMI was 26.8+4kg/m2. Pre- and post-donation kidney function were similar in both cohorts (Figure 1). LD practices differed in Italy and the US in the socioeconomic aspect of LD evaluation and in LD follow-up (Table 1).
Conclusion
Italy and the US differ in the socioeconomic aspect of LD evaluation and in post-donation follow-up practices. There were more donors who had HTN or were current smokers in UPO compared to JH. Despite these differences, short-term LD outcomes were comparable and excellent in both. A national health system may be an opportunity for better long-term donor follow-up.
Table 1. Differences in Donor Evaluation and Follow-up Practices in US and Italy
| US/Johns Hopkins University | Italy/University of Piemonte Orientale | |
| Evaluation | -Clearance from an Independent Living Donor Advocate (ILDA) -Work-up is covered by the recipient | -Requirement of judicial authorization and third party committee approval (comprised of hospital medical director, non-hospital nephrologist, and psychologist) -Option of kidney reserve measurement* -Work-up is covered by national health system |
| Follow-up | -Surgical follow-up post donation* -Case-to-case follow-up with donor nephrologist with option of telemedicine* -UNOS mandated 6, 12, and 24-month follow-up Living Donor Forms (includes information like development of HTN, kidney complications, readmission), urine protein, and serum creatinine -Long-term follow-up with primary care physician | -Long-term annual follow up with the transplant center (more frequent if indicated) |
*Practices specific to centers (not nationwide) UNOS-United Network for Organ Sharing
Figure 1. Pre- and Post-Donation Kidney Function