Living Kidney Donation Practices in Europe: A Survey of DESCaRTES and EKITA Transplantation Working Groups

Abstract

Thorough evaluation of potential kidney donors ensures safety and graft quality, but European data on donor practices are lacking. An online survey was conducted to assess European practices regarding kidney function, risk assessment and follow-up. 56% of respondents (125 practitioners, 16 countries, ∼3700 donations annually) use eGFR_CKD-EPI, 34% use creatinine clearance and 70% use measured GFR. Sixty-three percent have no upper age limits, 91% exclude candidates with hypertension with end-organ damage, and 78% candidates on ≥2 antihypertensives. BMI cut-offs of 30 (39%) and 35 kg/m² (42%) are common. Candidates are excluded for an HbA1c ≥ 53 mmol/mol (46%), glucose ≥7 (57%) or ≥11.1 mmol/L after glucose-tolerance test (59%). ApoL1-testing is not routine in 73%, and 38% perform a kidney biopsy if albuminuria/hematuria is present. Spot and 24-hour urine albumin is assessed in 38%. Hematuria is accepted when urological evaluation (15%), kidney biopsy (16%), or both (57%) are normal. Low-risk stones often do not preclude donation. Written informed consent is obtained by 95% of centers, with 65% asking consent for data. Lifetime follow-up is offered by 83%. This first study on evaluation and follow-up practices of donors in Europe shows variation between centers, suggesting a need for harmonization of donor practices.

Keywords: donor follow-up; donor screening; kidney function; living kidney donation; risk assessment.

FIGURE 1

Overview of respondents. Overview of respondents as percentage of transplant centers per country (left) and absolute numbers with percentage of all reponses (right). Source: ESOT YPT Map of active European transplant centers (accessed at https://esot.org/map/). Created using IMAGE Interactive Map generator (accessed at: https://gisco-services.ec.europa.eu/image/screen/home).

FIGURE 2

Transplant professionals involved in living kidney donor decision making. Overview of transplant professionals routinely involved in the selection of living kidney donation, expressed as percentage of all respondents (n = 125). When “Other” was selected, respondents were asked to specify: 2 (2%) respondents answered, “social worker,” 1 (1%) respondent answered “pharmacist,” 1 (1%) respondent answered “vascular surgeon” and 1 (1%) respondent answered “healthcare ethics committee” to be routinely involved in the selection of living kidney donors.

FIGURE 3

Kidney function assessment per country. Overview of routinely used tests for decision-making regarding kidney function of a potential LKD. Centers were asked which test they mainly use for decision-making: measured GFR (dark blue), 24-hour creatinine clearance (orange), a combination of these (green) or estimated GFR (light blue). Answers are expressed as percentage of all respondents (n = 125).

FIGURE 4

Overview of decision-making regarding proteinuria and albuminuria. Overview of decision-making regarding proteinuria/albuminuria in 24-hour urine and/or spot urines. Centers were asked which of the answers best represents their practice regarding the exclusion of donors with proteinuria. Multiple answers could be given. Answers are expressed as percentage of all respondents (n = 125). 12% of centers would accept donors with any proteinuria/albuminuria if they have a normal biopsy result.

FIGURE 5

Consensus overview of questionnaire items. Overview of rate of consensus on various questionnaire items. When multiple answers were possible, the most common answer is shown in the graph.