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      Arterial Hypertension as a Risk Factor for Reduced Glomerular Filtration Rate after Living Kidney Donation

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          Abstract

          Living kidney donation represents the optimal renal replacement therapy, but recent data suggest an increased long-term renal risk for the donor. Here, we evaluated the risk for reduced estimated glomerular filtration rate (eGFR), death, and major cardiovascular events such as nonfatal myocardial infarction or cerebrovascular event including TIA (transient ischemic attack) and stroke in 225 donors, who underwent pre-donation examinations and live donor nephrectomy between 1985 and 2014 at our center. The median follow-up time was 8.7 years (1.0–29.1). In multivariate analysis, age and arterial hypertension at baseline were significantly associated with a higher risk of adverse renal outcomes, such as (1) eGFR <60 mL/min/1.73 m 2 (age per year: HR (hazard ratio) 1.05, 95% confidence interval (CI) 1.03–1.08, hypertension: HR 2.25, 95% CI 1.22–3.98), (2) eGFR <60 mL/min/1.73 m 2 and a decrease of ≥40% from baseline (age: HR 1.08, 95% CI 1.03–1.13, hypertension: HR 4.22, 95% CI 1.72–10.36), and (3) eGFR <45 mL/min/1.73 m 2 (age: HR 1.12, 95% CI 1.05–1.20, hypertension: HR 5.06, 95% CI 1.49–17.22). In addition, eGFR at time of donation (per mL/min/1.73 m 2) was associated with a lower risk of (1) eGFR <60 mL/min/1.73 m 2 (HR 0.98, 95% CI 0.97–1.00) and (2) eGFR <45 mL/min/1.73 m 2 (HR 0.95, 95% CI 0.90–1.00). Age was the only significant predictor for death or major cardiovascular event (HR 1.08, 95% CI 1.01–1.16). In conclusion, arterial hypertension, lower eGFR, and age at the time of donation are strong predictors for adverse renal outcomes in living kidney donors.

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          High survival rates of kidney transplants from spousal and living unrelated donors.

          In the United States, increasing numbers of persons are donating kidneys to their spouses. Despite greater histoincompatibility, the survival rates of these kidneys are higher than those of cadaveric kidneys. We examined the factors influencing the high survival rates of spousal-donor kidneys. Kidney-transplant data from the United Network for Organ Sharing Renal Transplant Registry were used to calculate graft-survival rates with Kaplan-Meier analysis. The three-year survival rates were 85 percent for kidneys from 368 spouses, 81 percent for kidneys from 129 living unrelated donors who were not married to the recipients, 82 percent for kidneys from 3368 parents, and 70 percent for 43,341 cadaveric kidneys. The three-year survival rate for wife-to-husband grafts was 87 percent, which was the same as for husband-to-wife grafts if the wife had never been pregnant. If the wife had previously been pregnant, the three-year graft-survival rate was 76 percent (P = 0.40). The three-year graft-survival rate among recipients of spousal grafts who did not receive transfusions preoperatively was 81 percent, as compared with 90 percent for recipients who received 1 to 10 transfusions preoperatively (P = 0.008). The superior survival rate of grafts from unrelated donors could not be attributed to better HLA matching, white race, younger donor age, or shorter cold-ischemia times, but might be explained by damage due to shock before removal in 10 percent of the cadaveric kidneys. Spouses are an important source of living-donor kidney grafts because, despite poor HLA matching, the graft-survival rate is similar to that of parental-donor kidneys. This high rate of survival is attributed to the fact that the kidneys were uniformly healthy.
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            Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

            Abstract Kidney Disease: Improving Global Outcomes (KDIGO) engaged an evidence review team and convened a work group to produce a guideline to evaluate and manage candidates for living kidney donation. The evidence for most guideline recommendations is sparse and many “ungraded” expert consensus recommendations were made to guide the donor candidate evaluation and care before, during, and after donation. The guideline advocates for replacing decisions based on assessments of single risk factors in isolation with a comprehensive approach to risk assessment using the best available evidence. The approach to simultaneous consideration of each candidate’s profile of demographic and health characteristics advances a new framework for assessing donor candidate risk and for defensible shared decision making.
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              Mid- and Long-Term Health Risks in Living Kidney Donors

              Long-term health risks for adults who donate kidneys are unclear.
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                Author and article information

                Journal
                J Clin Med
                J Clin Med
                jcm
                Journal of Clinical Medicine
                MDPI
                2077-0383
                25 January 2020
                February 2020
                : 9
                : 2
                : 338
                Affiliations
                [1 ]Department of Internal Medicine IV, Nephrology and Hypertension, Medical University Innsbruck, Anichstraße 35, 6020 Innsbruck, Austria; Stefanie.Bitter@ 123456ordensklinikum.at (S.B.); m.weitlaner@ 123456tirol-kliniken.at (M.W.); hannes.neuwirt@ 123456i-med.ac.at (H.N.); gert.mayer@ 123456i-med.ac.at (G.M.); michael.rudnicki@ 123456i-med.ac.at (M.R.)
                [2 ]Department of Visceral, Transplant, and Thoracic Surgery, Medical University Innsbruck, 6020 Innsbruck, Austria; katrin.kienzl@ 123456tirol-kliniken.at (K.K.-W.); claudia.boesmueller@ 123456tirol-kliniken.at (C.B.); stefan.schneeberger@ 123456tirol-kliniken.at (S.S.)
                Author notes
                Author information
                https://orcid.org/0000-0003-1064-0098
                Article
                jcm-09-00338
                10.3390/jcm9020338
                7073681
                31991745
                570fd77d-1eef-4bb0-bbc4-3e24fef610a8
                © 2020 by the authors.

                Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 23 December 2019
                : 21 January 2020
                Categories
                Article

                arterial hypertension,living kidney donation,chronic kidney disease

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