Live Donor Registry

Steve Chadban

Transplant numbers

0

200

400

600

0

50

100

150

199

01

991

199

21

993

199

41

995

199

61

997

199

81

999

200

02

001

200

22

003

200

42

005

200

6

199

01

991

199

21

993

199

41

995

199

61

997

199

81

999

200

02

001

200

22

003

200

42

005

200

6Australia New Zealand

Cadaveric Live related Live unrelatedDonor source

Num

ber

ANZDATA, Tx numbers by year and source

Impaired kidney functionCalculated GFR (body surface area

adjusted)

Median and interquartile range

Age 25-34 35-44 45-54 55-64 65-74 75+

IFG

%

2.0 5.2 7.2 8.7 7.6 6.8

IGT

%

3.4 6.5 10.0 15.2 21.2 23.2

New DM

0.1 1.4 2.9 6.6 8.5 12.1

Known DM

0.2 1.0 3.3 6.5 9.4 10.9

Prevalence of abnormal glucose metabolism* in Australian Adults, AusDiab 1999-2000.

*WHO criteria after OGTT Dunstan etal. Diabetes Care 2002;25:829-34

Patients who have undergone unilateral nephrectomy who are obese:

Praga et al. KI 2000;58:2111

Risk of ESKD after kidney donation - USA

• Kidney donors on waiting list 0.15%– Incidence

• white < 50 0.04%• Black <50 0.2%

– Significantly greater than risk in age matched popgen pop donor

• White 30-39 0.008 0.1• Black 0.04 0.52

– Cause of ESRF• FSGS• DM

– 20-50% have a family Hx of DM– Age at donation 38.5y– Age at ESRF 49

Connie Davis, ATC 2005

Pre-donation data

• Commenced 2004, data 2004-6 = 764 (>95%)

• Age 48+/-11yrs, 25%>57, 18%>60 • F 56%, M 44%, 89% caucasian• 62% related, 22%spousal, 15% other LURD• SCr 78+/-15 umol/L, 25%>88 • GFR 112 +/-30, GFR<96 in 25%

– Nuc GFR (n=329) 117+/-23, 25% <100, 2%<80– MDRD or CrCl (n=250) 107 +/-36, 25%<76, 29%<80

Pre-donation data

• SCr 78+/-15 umol/L, 25%>88 • GFR 112 +/-30, GFR<96 in 25%

– Nuc GFR (n=329) 117+/-23, 25% <100, 2%<80– MDRD or CrCl (n=250) 107 +/-36, 25%<76, 29%<80

• Proteinuria (n=627 or 82%)– Mean 0.12g/day– >0.20g/d in 21 (3.3%)

Pre-donation data

• BMI 26 +/-4.0 – 16% 30-35, 2.3% > 35• Diabetes – known (10) + OGTT (14) = 24 (3%)

– OGTT reported 70%, 81% normal, 17% IFG, 2% DM– +FHx in 21%– 2 diabetic donors with BP>140/90

• BP 125/75 +/- 13/9– Systolic BP >140 in 6%, DBP >90 in 2.7%, >140/90 in

1.6%

• Smoking – 8.3%

Follow-up post-nephrectomy

• 1 year = 23%, 2 year = 15%• 1yr follow-up (n=235):

– SBP 124±13– DBP 75±8– New hypertension 10%– SCr 108±23– MDRD 59±12 – 25% <51– PCR (n=75) 5.6±5.5– Reported problems (n) – elevated SCr (6), proteinuria

(3), pain (1), IgA (1), retroperitoneal fibrosis (1).

Key Issues

Follow-up – non-mandated but crucial!• Current follow-up data not useful• Frequency of ESKD among donors, mortality• Outcomes at extremes of GFR

– Hyperfiltration – GFR>140 with low-grade proteinuria– Low baseline GFR – typically elderly, impact on CVS outcomes

• Proteinuria – development, evolution, relationship to BMI, diabetes

• BP – kidney, CVS and BP outcomes among hypertensives, smokers

• Controls