Metabolic, cardiovascular, and substance use evaluation of living kidney donor candidates: US practices in 2017

Abstract

We surveyed US transplant centers to assess practices regarding the evaluation and selection of living kidney donors based on metabolic, cardiovascular, and substance use risk factors. Our companion article describes renal aspects of the evaluation. Response rate was 31%. Compared with 2005, programs have become more accepting of hypertensive candidates: 65% in 2017% vs 41% in 2005 consider candidates with hypertension well controlled with 1 medication. One notable exception is black hypertensive candidates, who are frequently excluded regardless of severity. The most common body mass index (BMI) cutoff remains 35 kg/m 2 , and fewer programs now consider candidates with BMI >40 kg/m 2. A 2-hour oral glucose tolerance test of ≥140 mg/dL remains the most common criterion for exclusion of prediabetic candidates. One quarter to one third of programs exclude based on isolated cardiac abnormalities, such as mild aortic stenosis; a similar proportion consider these candidates only if older than 50 years. Cigarette or marijuana smoking are infrequently criteria for exclusion, although 45% and 37% programs, respectively, require cessation 4 weeks prior to surgery. In addition to providing an overview of current practices in living kidney donor evaluation, our study highlights the importance of research evaluating outcomes with various comorbidities to guide practice.

Opinions of African American adults about the use of apolipoprotein L1 (ApoL1) genetic testing in living kidney donation and transplantation

“…Most transplant programs do not offer ApoL1 testing and, when it is offered, view high‐risk genotype as an absolute contraindication to donation 33 . This is surprising considering that two thirds of programs accept PLDs with other risk factors, such as hypertension and obesity 34 . Our survey findings are consistent with prior qualitative studies suggesting that high‐risk genotype should be considered only as 1 factor in overall decision‐making about living donation.…”

Survey of US Living Kidney Donation and Transplantation Practices in the COVID-19 Era

“…However, the 61% response rate is higher than many contemporary studies of transplant program practices (where response rates in 30%-range are common), 14 , 26 , 27 likely reflecting the strong community interest in the topic, and the responding centers represent 75% of LDKT volume in the period. Per prior methods, 26 , 27 , 28 we applied an a priori methodology to select one representative survey per program favoring completeness and clinical role that was blind to the responses, but results may have varied somewhat with other methodologies. These survey data reflect the opinions and experiences of the respondents at the time of completion, and given the rapidly dynamic nature of the COVID-19 pandemic, may not be reflective of subsequent practice.…”

“…Respondents were identified by online outreach to US transplant professionals, and not all programs are represented. However, the 61% response rate is higher than in many contemporary studies of transplantation program practices (where response rates in the vicinity of 30% are common), 14,26,27 likely reflecting the strong community interest in the topic, and the responding centers represent 75% of LDKT volume in the period. Per prior methods, 26À28 we applied an a priori methodology to select 1 representative survey per program favoring completeness and clinical role who was blinded to the responses, but results may have varied somewhat with other methodologies.…”

The kidney evaluation of living kidney donor candidates: US practices in 2017

“…A companion report focuses on the metabolic, cardiovascular, and substance use aspects of the evaluation. 14…”