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.

FIGURE 1

Perspectives of risk in living kidney donation. These perspectives provide a framework for assessment of donor outcomes, interpretation of observations, patient communication, and future research design. LKD, living kidney donors. Reprinted with permission from Reproduced with permission from Lentine KL, Segev DL. Understanding and communicating medical risks for living kidney donors: a matter of perspective. J Am Soc Nephrol. 2017;28:12–24.

FIGURE 2

Framework to accept or decline donor candidates based on a transplant program’s threshold of acceptable projected lifetime risk of kidney failure, quantified as the aggregate of risk related to demographic and health profile and donation-attributable risks. The decision by a transplant program to accept or decline a donor candidate is grounded on whether an individual's estimated projected postdonation lifetime risk is above or below the threshold set (dotted line) by the transplant program. Lifetime risk is comprised of estimated risk in the absence of donation (ie, related to donor demographic and health characteristics, as denoted in blue and beige, respectively) and estimated projected risk attributable to donation (brown). The threshold may vary across transplant programs, but the same threshold should apply to all donor candidates at each program. For example, candidate A would be acceptable because the estimated projected postdonation risk is far below the threshold. Candidate B could be accepted with caution because the estimated projected postdonation risk is close to the threshold, and candidate C would be unacceptable because the estimated postdonation projected risk is far above the threshold.

FIGURE 3

Sequential evaluation of microscopic hematuria in living kidney donor candidates. AER, albumin excretion rate; GFR, glomerular filtration rate; hpf, high-power field; RBC, red blood cell.