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Kidney Week

Abstract: SA-PO974

Long-Term Risk of ESKD in Kidney Donors with Diabetes Mellitus Using eGFR 6 Months after Donation

Session Information

Category: Transplantation

  • 2102 Transplantation: Clinical

Authors

  • Gaur, Lovy, Max Superspeciality Hospital Vaishali, Ghaziabad, NCR, Uttar Pradesh, India
  • Singhal, Manoj Kumar, Max Superspeciality Hospital Vaishali, Ghaziabad, NCR, Uttar Pradesh, India
Background

Traditionally,diabetes mellitus was considered contraindication for kidney donation.Guidelines now recommend evaluation of such donors on case-to-case basis.Estimated GFR at 6 months post-donation(eGFR6) may be surrogate for long-term risk of ESKD.As per a study, 15-year cumulative incidence of ESKD with eGFR6 >70 ml/min was estimated to be 11.7/10000 donors against 33.7/10000 donors if eGFR6< 50ml/min. We demonstrate potential safety of donors with diabetes using eGFR6.

Methods

Potential kidney donor with diabetes mellitus were evaluated only after exploring other voluntary family members’ feasibility to donate.As per KDIGO recommendations,older diabetic candidates with well-controlled glycemia,not requiring insulin & without end-organ damage were considered.Donors were deemed eligible only if pre-donation projected 15-year-risk of ESKD was <1% as estimated by ESRD-Risk tool for living kidney donors(NYU Langone’s Center for Surgical & Transplant Applied Research(C-STAR)).Independent assessment of potential donors by Internal Hospital Medical Board was also done.

Results

345 patients received kidney transplantation from Jan 2019 to Dec 2023. 9 kidney donors with diabetes (mean age-60.7yrs),with follow-up of > 6months were included.8 donors were detected to have diabetes during work-up for donation & 1 had been diabetic for 5 years and 5 had hypertension.Mean HbA1C was 6.7%.Mean pre-donation creatinine was 0.75 mg/dl(eGFR- 92.84 ml/min), urine albumin-creatinine ratio was 20.29.Mean DTPA-GFR of retained kidney was 41.42 ml/min.
Mean follow up was 20.6 months (6-48 mon).Average eGFR at 6 months was 59.8 ml/min.Only 1 donor (aged 72 years) had eGFR6 < 50ml/min (38 ml/min).On her last-follow-up at 24 months,she continues to do well (creatinine-1.29,UACR <30).
Graft outcomes were good. Only 1 graft was lost to plasma-cell rich rejection at 6 months post-transplant.Another patient who was biopsied 2 weeks after transplant had mild ATN,which recovered gradually.None of these patients had histopathological changes of diabetic nephropathy.

Conclusion

Our study demonstrates safety of diabetic kidney donors using eGFR6 as a surrogate for long-term risk of ESKD.More long-term studies are required to substantiate this risk. In certain exceptional circumstances,donation from diabetic donors may be considered, considering intangible effects of recipient health on donor well-being.