Introduction:
Traditionally, diabetes mellitus was considered contraindication for kidney donation. Guidelines now recommend evaluation of such donors on a case-to-case basis. Estimated GFR at 6 months post- donation(eGFR6) may be a 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 and without end-organ damage were considered. Donors were deemed eligible only if the 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)). Eligible donors were also independently screened by an Internal Medical Board comprising Medical Adminstrator, Physician, Endocrinologist and Urologist.
Results:
345 patients received kidney transplantation at our centre from Jan 2019 to Dec 2023. Of these 12 patients received kidney transplant from diabetic donors. 9 kidney donors with diabetes (mean age-60.7yrs),with follow-up of > 6months were included in this study. 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 fasting and post-prandial blood sugars were 117.5mg/dl and 154 mg/dl respectively. 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 months). Serum creatinine averaged 1.2 mg/dl, 1.1 mg/dl, 1.1 mg/dl and 1.15 mg/dl at 3, 6,, 12 and 18 months respectively. 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.
Conclusions:
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.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.