16. Reasons for disapproval of potential living kidney donors

P.H.M.M. Dooper, A. Rasing, D.B. Pilzecker, C.W. Hooghof, E.M. van Ommen, F.C.H. d' Ancona, H.L. Langenhuijsen, X. Zhu, M. van der Jagt, M. Warle, H.J. Kloke

Thursday 5 march 2020

0:00 - 0:00h at Toon Hermans Foyer

Parallel session: Postersessie 4 – Donatie en Verpleegkundige abstracts

Background: During the last decades the number of living kidney donors (LKD) has increased considerably in our centre, partly due to the allowance of HLA mismatched LKD and because of more liberal selection criteria (older age, higher BMI and pre-existent hypertension). Previously we showed that the percentage of approval for donation decreased with increasing donor age. In the current study we investigated the role of gender and endogenous creatinine clearance (ECC) as cause for refusal.

Methods: After an initial informative visit potential LKD proceed with medical examinations. At both visits contraindications for donation can be found. The results of the screening are registered in our NOTR database. We retrospectively analysed the evaluation results in a cohort of LKD candidates who were registered between May 15^th 1997 and May 24^th 2019.

Reasons for refusal were categorized in four groups: 1) psychosocial reasons or the availability of another LKD candidate (e.g. with a better fitting blood type), 2) medical reasons (e.g. proteinuria, extreme overweight, hypertension, diabetes, kidney stones, malignancy), 3) surgical renal reasons (e.g. renal veins considered too short, renal cysts, multiple arteries or asymmetrical renal function) and 4) insufficient renal function (ECC considered to low).

Results: In this period 531 LKD candidates were not accepted for kidney donation, mean age was 55 years (range 20-80), 281 of them were women. Psychosocial reasons or another LKD candidate were the reason for refusal in 98 (19% of 531) (55 women, mean age 51 years). Medical reasons were the cause of refusal in 289 (54%) (142 women, mean age 55 years). Surgical renal reasons were the main cause of refusal in 102 (19%) (53 women, mean age 57 years). Insufficient renal function as only cause for refusal was registered in 42 (8%) (31 women, mean age 61 years). Mean ECC in this group was 76 ml/min (range 43-104). In the other three groups mean ECC was 116 to 119 ml/min (range 53-228).

Conclusions: In the medical and surgical group often several reasons for refusal were registered, e.g. multiple renal vessels with relatively low ECC or asymmetrical kidney function. Reasons for refusal were equally distributed between both sexes in the psychosocial, medical and surgical group. In the rather small group with insufficient renal function women were in the majority with a slightly higher age confirming the known lower ECC in women and gradual decline of kidney function with higher age.