Kidney transplantation has evolved significantly since the first attempts in the 1930s. Live donor kidney transplantation provides advantages over deceased donor transplants including better outcomes. A comprehensive evaluation of potential live kidney donors is essential and includes medical, surgical, immunological, and psychosocial assessments. Careful evaluation aims to minimize risks to donor health while maximizing the benefits of transplantation for recipients. Ongoing research continues to further develop and improve the live donor evaluation and transplantation process.

1. Kidney Transplantation:
The Donor Story
By
Dr. Ahmed Mohammed Abd El Wahab
Lecturer of internal medicine
(Nephrology)
Mansoura University

2. History
The first human kidney allograft by Voronoy in 1933

3. Transplantation Reviews 27 (2013) 50–56
History

4. Ronald & Richard Herrick
December 23rd 1954
Boston, Massachusetts

5. History (1976)
N=2682

6. WHY ?

7. Hemodialysis
N Engl J Med 2007;357:1316-25.

8. Pre-emptive Transplantation:
Patients’ Survival

9. The Challenge
Clin J Am Soc Nephrol 5: 1873–1880, 2010

10. • Finland: 3.3%
• France: 8%
• Belgium: 12%
• Germany: 21.6%
• UK: 47%
• USA: 49.5%
• Netherlands: 63.8%
• Japan: 80%
• Egypt and Pakistan: 100%
Prevalence of Live Kidney Donors
Nephrol Dial Transplant (2012) 27: 41–50

11. Types of Live Donors
Directed
1. Genetically Related
2. Emotionally Related
Non- directed
1. Altruistic Donors
2. Organ Exchangers
3. Vendors???????

12. Nephrology Self-Assessment Program - Vol 10, No 6, November 2011
Donor Exchange

13. Advantages of Live Donor Kidney
Transplantation
Clin. Transplant. 2006;20(17):13–16.

14. Arch Surg. 2010;145(4):356-362
The Outcome
6320 cases mortality: 0%
a complication rate of 18.4%.
3698 kidney donors
N Engl J Med 2009;360:459-69

15. B J U I N T E R N A T I O N A L
 Hypertension: 22%
 Diabetes: 6.8%
 Proteinuria:
 > 150 mg/24h: 1.8%
 > 300 mg/24h: 1.5%
8/2000
339
Outcome:
Mansoura Experience

16. • Pregnancy---delayed for 6m post-donation
• HTN
• CKD
• Mortality
• Work and Insurance
Outcome

17. MDT
Transplant
Nephrologist
Transplant
Surgeon
Pathology
Lab
Radiologist
Immunology Lab
System

19. Donor Evaluation
• Initial (Screening ) ----- Hx., exam.
• Second (Immunological )
• Third ( Fitness) ----- Invest.
• Fourth ( Psycho-Social )
• Fifth (Surgical imaging)
• Final re-do cross match

20. STEPS

21. Donor Evaluation

23. Amsterdam forum guidelines

24. COMPREHENSIVE CLINICAL NEPHROLOGY , 2015

25. Amsterdam forum guidelines

26. Amsterdam forum guidelines

27. Amsterdam forum guidelines

28. Donor evaluation
• Social survey :
- Very crucial
- Especially in underdeveloped countries
- Specialized social workers
- Commercial related donation
- Female discrimination (Younger sisters)

29. Components of the psychosocial
evaluation of living kidney donors

30. Immunological assessment

31. HLA Matching
Comprehensive textbook of Nephrology 2010
Newsletter; 2 March 2013

32. Blood Grouping
DonorRecipient
A or OA
B or OB
AllAB
OO
Transplantation 2004;78: 1693–1696)

33. Donor evaluation
• Surgical Imaging survey components :
- Imaging of the renal vasculature
- Imaging of pelvi-calyceal system
- Split renal function (renogram)

34. Donor evaluation
• Surgical Imaging aims :
- To choose the kidney with
single artery
more lengthy artery
absent pelvi-calyceal anomalies
lower split function

35. Techniques
• Past: UTP, IVU, Aortography
• Now:
1. MRA, MRV, MRU
2. CTA, CTV, CTU
3. Renogram

40. Donor Special Issues

41. Race and Gender

43. Incidentlomas

44. Old Age Donors

45. Impact Of Donor Old Age On Renal Transplant
Outcome
American Journal of Transplantation 2011; 11: 1279–1286

46. 30
 Hereditary nephritis: 25/30
 Isolated C3 deposited disease: 3/30
 IgA nephropathy: 1/30
 IgM nephropathy: 1/30
Hematuria

47. Glucose Intolerance:
Japanese Single Center Experience
Transplantation 2010;89: 1391–1395
• Live donors: 444 (75 gm OGT):
–Normoglycemia: 373
–Glucose intolerance:
–Diabetes: 27
–IGT: 44
Clin J Am Soc Nephrol 6: 2054–2059, 2011.

48. Arab Journal of Urology, 9: 235-239, Dec 2011
Hyperechogenicity

49. Transplantation Proceedings, 42, 2436–2446 (2010)
HCV

50. Schistosomiasis
Uncomplicated schistosomiasis in living kidney donors does not adversely affect either the
function or the morphology of the remaining kidney, at least during an observation period of
up to five years, provided that schistosomiasis was treated before kidney donation.

51. • If +ve family Hx.------test for ANA(40 fold risk)
• If +ve family Hx. for SLE with thrombotic attack or
livido reticularis----- test for APL
SLE

52. • Recurrent bacteruria, pyuria, hematuria warrant
testing
• Prospective donators should be warned against
medullary carcinoma
Sickle cell trait

53. • ADPKD
• Alport syndrome
• TBMD
• Familial FSGS
Inherited renal disorders

56. Challenges are
what make life
interesting;
Overcoming them
is what makes life
meaningful.
JOSHUA J. MARINE

57. THANK YOU