The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review

Habbous, Steven; Woo, Justin; Lam, Ngan N.; Lentine, Krista L.; Cooper, Matthew; Reich, Marian; Garg, Amit X.

doi:10.1097/txd.0000000000000833

Cited by 23 publications

(13 citation statements)

References 82 publications

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“…Other workers showed that renal volume calculation using the ellipsoid method ( length x antero-posterior diameter x lateral diameter x π/6 ) compared favourably with volume determined using volumetric software[ 20 ]. CT volume can replace nuclear renography for evaluation of relative function, as volume has been shown as a surrogate marker for nephron mass[ 12 , 21 - 24 ].…”

Section: Discussionmentioning

confidence: 99%

Living kidney donor assessment: Kidney length vs differential function

Akoh

Schumacher

2020

WJT

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BACKGROUND The key question in living kidney donor assessment is how best to determine the contribution of each kidney to overall renal function and guide selection of which kidney to donate, ensuring safety of procedure and good outcome for both recipient and donor. It is thought that a length difference > 2 cm may indicate significant difference in function and therefore need for measurement of differential function. AIM To determine the effect of using kidney length to decide which kidney to donate in a retrospective cohort of potential donors. METHODS All 333 potential living kidney donors between January 2009 and August 2018 who completed assessment were retrospectively evaluated. Donor assessment was performed as per United Kingdom guidelines. Data included age, sex, kidney length (cranio-caudal) obtained by computed tomography/ultrasono-graphy,51-chromium ethylenediamine tetraacetatic acid measured glomerular filtration rate, mercapto acetyl tri glycine split function and vascular anatomy. There were 48 exclusions due to inadequate data or incomplete investigations. Statistical analysis was performed using Excel pivot tables and GraphPad Prism. Correlation between kidney length and differential function was determined with Pearson’s correlation coefficient. RESULTS Of 285 potential donors included in the study, there were 144 males (mean age 49.9 ± 14.75) and 141 females (mean age 51.2 ± 11.23). Overall, the Pearson’s correlation between differences in length and divided function of kidney pairs was 0.1630, P = 0.0058. Of 73 with significant difference (> 10%) in divided function, 18 (24.7%) had no difference in kidney length; 54 (74%) had a difference of < 2 cm and only one of > 2 cm. Using a length difference of > 1 cm would only predict significant difference in divided function in 8/34 (23.5%) of cases. Using a difference of > 2 cm as cut off for performing split function would lead to false reassurance in 72 patients (6 had > 20% difference in divided function whereas 66 had 10%-20% difference). CONCLUSION Length difference between kidney pairs alone is not sufficient to replace measurement of divided function. This issue requires a randomised controlled trial to resolve it.

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Section: Discussionmentioning

confidence: 99%

Living kidney donor assessment: Kidney length vs differential function

Akoh

Schumacher

2020

WJT

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“…The surveys included key terms used to define a concept, process indicators that measure program activities, and outcome indicators that measure clinical events. We first identified and developed initial terms and indicators through conversations with various stakeholders and after a scoping review of the literature (Figure 1) (1,12). Each indicator was reviewed by the research team to ensure it was comprehensible for all audiences, yet specific enough so that each indicator only represented one concept.…”

Section: Survey Developmentmentioning

confidence: 99%

“…Many patients and providers perceive the living kidney donor candidate evaluation process to be difficult to navigate and lengthy, exceeding 10 months at many transplant centers (1)(2)(3). A prolonged evaluation can frustrate the living kidney donor candidates, their intended recipients, and health care providers, particularly if they feel the intended recipients are remaining on dialysis longer than is needed (2,4,5).…”

Section: Introductionmentioning

confidence: 99%

“…The development and use of standardized definitions for key terms and quality indicators would facilitate the creation of such benchmarks, provide insight into bottlenecks in the living donor evaluation process, and enable meaningful comparisons within and across transplant centers over time (9). It would also provide a measurement framework to evaluate the effects of different options to perform the evaluation (e.g., scheduling multiple specialist consultations on the same day, evaluating many candidates simultaneously for the same recipient) (1,3).…”

Section: Introductionmentioning

confidence: 99%

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A RAND-Modified Delphi on Key Indicators to Measure the Efficiency of Living Kidney Donor Candidate Evaluations

Habbous

Barnieh

Litchfield

et al. 2020

CJASN

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Background and objectivesMany patients, providers, and potential living donors perceive the living kidney donor evaluation process to be lengthy and difficult to navigate.Design, setting, participants, & measurementsWe sought consensus on key terms and process and outcome indicators that can be used to measure how efficiently a transplant center evaluates persons interested in becoming a living kidney donor. Using a RAND-modified Delphi method, 77 participants (kidney transplant recipients or recipient candidates, living kidney donors or donor candidates, health care providers, and health care administrators) completed an online survey to define the terms and indicators. The definitions were then further refined during an in-person meeting with ten stakeholders.ResultsWe identified 16 process indicators (e.g., average time to evaluate a donor candidate), eight outcome indicators (e.g., annual number of preemptive living kidney donor transplants), and two measures that can be considered both process and outcome indicators (e.g., average number of times a candidate visited the transplant center for the evaluation). Transplant centers wishing to implement this set of indicators will require 22 unique data elements, all of which are either readily available or easily collected prospectively.ConclusionsWe identified a set of indicators through a consensus-based approach that may be used to monitor and improve the performance of a transplant center in how efficiently it evaluates persons interested in becoming a living kidney donor.

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“…Most centres screen one candidate at a time and adopt a multiple-step screening (i.e. a progressive screening that consists in multiple days assessment) [3]. This approach limits the number of candidates who undergo in-depth evaluation to reduce the burden of the screening.…”

Section: Introductionmentioning

confidence: 99%

Living kidney donor evaluation for all candidates with normal estimated GFR for age

et al. 2021

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Multiple days assessments are frequent for the evaluation of candidates to living kidney donation, combined with an early GFR estimation (eGFR). Living kidney donation is questionable when eGFR is <90 ml/min/1.73 m 2 (KDIGO guidelines) or 80 ml/min/1.73 m 2 (most US centres). However, age-related GFR decline results in a lower eGFR for older candidates. That may limit the number of older kidney donors. Yet, continuing the screening with a GFR measure increases the number of eligible donors. We hypothesized that in-depth screening should be proposed to all candidates with a normal eGFR for age. We compared the evolution of eGFR after donation between three groups of predonation eGFR: normal for age (S age ) higher than 90 or 80 ml/min/1.73 m 2 (S 90 and S 80, respectively); across three age groups (<45, 45-55, >55 years) in a population of 1825 French living kidney donors with a median follow-up of 5.9 years. In donors younger than 45, postdonation eGFR, absolute-and relative-eGFR variation were not different between the three groups. For older donors, postdonation eGFR was higher in S 90 than in S 80 or S age but other comparators were identical. Postdonation eGFR slope was comparable between all groups. Our results are in favour of in-depth screening for all candidates to donation with a normal eGFR for age.

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The Efficiency of Evaluating Candidates for Living Kidney Donation: A Scoping Review

Abstract: Supplemental digital content is available in the text.

Cited by 23 publications

References 82 publications

Living kidney donor assessment: Kidney length vs differential function

Living kidney donor assessment: Kidney length vs differential function

A RAND-Modified Delphi on Key Indicators to Measure the Efficiency of Living Kidney Donor Candidate Evaluations

Living kidney donor evaluation for all candidates with normal estimated GFR for age

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