E CASH1, A GRAVER2, S KUO2, G KIRKLAND2, P HUGHES3, A ROBERTSON3, MD JOSE1,2
1 School of Medicine, University of Tasmania; 2On behalf of the Renal Unit, Royal Hobart Hospital, Tasmania; 3On behalf of the Department of Nephrology, Royal Melbourne Hospital, Victoria.
Aims: To identify reasons for non-donation by comparing the risk-factor profile of living kidney donor candidates (LKDC) in those we accept versus those not accepted.
Background: The number of living kidney donors in Australia has not increased for many years. We examined the risk factor profile of all LKDC presenting to our unit to compare those accepted versus not, to better understand non-acceptance.
Methods: Retrospective review of all LKDC referred between 2006-2017. Comparison of pre-donation risk factor profile against Caring for Australasians with Renal Impairment (CARI) and Kidney Disease: Improving Global Outcomes (KDIGO) guidelines for donor acceptance and CKD-Prognosis Consortium risk calculators (transplantmodels.com) of end-stage kidney disease (ESKD) pre & post donation.
Results: 116 people were referred (51% female, mean 59 years) as LKDC. Of these, 57 (49%) progressed to donation, 32 (28%) did not donate and 16 (14%) remain under assessment pre-donation. LKDC were not accepted for donation due to an identified current health issue (60%), the presence of risk factors for long-term ESKD (17%), social reasons (13%) or positive cross-match (7%). Social reasons consisted of withdrawal after education and assessment. Those accepted were more likely to be younger (52.2 v 58.2 years), have no contraindications (84% v 32%, p<0.001), have never smoked (82% v 27%, p<0.01) and have lower projected 15 year (0.08% v 0.19%) and lifetime (0.26% v 0.40%) incidence of ESKD. However, the estimated risk of developing ESKD at 20 years post-donation was not different between those accepted or not (0.44% v 0.46%).
Conclusions: LKDC are not accepted due to current health issues and have a higher lifetime risk of ESKD. Nearly all accepted donors meet current guidelines.