Reasons for Non Progression of Potential Live Donor and Recipient Pairs to Renal Transplantation

Abstract

Introduction: Static deceased donor rates are helping increase the demand for live donor renal transplantation. With new initiatives in live donor renal transplantation such as ABO incompatible and paired exchange it is important to understand the reasons for potential live donor pairs not proceeding to transplantation. Methods: Retrospective review of records held from 2003-2007 of results of assessment of blood group compatible prospective live kidney donor and recipient pairings. The number declined for ABO incompatibility cannot be reliable determined. Results: 151/306(49%) of potential pairs did not proceed to transplantation. Reasons for non progression to transplantation were donor issues in 65/151(43%), a positive X-match in 47/151(31%), recipient issues in 39/151(26%). In potential donors issues precluding donation were medical in 24/65(40%)[abnormal GFR 10; diabetes 8; cardiac 6], followed by psychosocial in 21/65(32%) and problems with renal anatomy on imaging 9/65(14%). In recipients medical issues in 34/39(87%) most frequently precluded transplantation followed by psychosocial issues in 5/39(13%). Recipient medical issues predominantly included cardiac in 8/34(23%), malignancy in 5/34(15%), ongoing treatment of hepatitis C in 4/34(12%), complications of diverticular disease in 3/34(9%). Renal function stabilised in 4/34(12%) of these recipients precluding transplantation in the short term. Two recipients (6%) were deemed to not be suitable for ABOI renal transplantation (programme commenced mid 2007), due to high Antibody titres and 2/34(6%) recipients deceased during the workup period. Conclusions: In the last 5 years close to 50% of potential live donor renal transplant pairs did not proceed to transplantation. This has implications both for resourcing of the programme and future strategies that may allow transplantation between pairs previously turned down during workup.