Living elderly kidney donors: more investigations, lesser kidneys

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L.L. de Haan, F.A. d'Ancona, H. Langenhuijsen, M. van der Jagt, M. Warle, Ph.M.M Dooper, H.J. Kloke

Chair(s): dr. Marion J. Siebelink, programmamanager Transplantatie Centrum, UMC Groningen & dr. Raechel J. Toorop, transplantatiechirurg, UMC Utrecht

Thursday 10 march 2016

9:40 - 9:50h at Zaal 14

Categories: Parallelsessie (donatie)

Parallel session: Parallelsessie IX - Donatie en Allocatie

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Introduction:
Over the years the number of elderly living kidney donors (LKD) has increased considerably.  Elderly donors often suffer from chronic diseases that need further investigations to determine whether they can safely be approved for donation. We investigated whether these elderly donors  underwent additional preoperative examinations (for example referral to a cardiologist or MAG3-scan) and whether there were more refusals for donation compared to the younger donor age group. 

Methods:
After an initial informative visit potential LKD without an immediately obvious contraindication for donation proceeded with medical examinations. In our NOTR database we analyzed the data of 379 potential LKD who visited the nephrologist in 2011 till 2013. Patients were divided in two age groups: 18-59 years (group 1, n=249) and 60-76 years (group 2, n=130). We investigated the outcome of the donor screening procedure at least one year after the first medical examination. Chi-square tests were used for statistical analysis. 

Results:
The percentage of referrals and additional investigations increased with donor age: 45% and 65% (p< 0.001) in group 1 and 2, respectively. The percentage of patients not accepted for donation increased from 15% to 33% (p< 0.001) in  group 1 and 2. Refusals were highest in the subgroup above 69 years, i.e. 46%. Reasons for refusal were mainly kidney related:  6% and 19% (p<0.01) in group 1 and 2, respectively. The percentages of non-kidney related medical reasons contributed less to  refusal  in the young and old age group, i.e. 5% and 8% (p< 0.05). Finally, psychosocial reasons caused refusals in 4% and 6% in group 1 and 2 (NS), respectively. 

Conclusion: 
With increasing donor age medical referrals and thus medical examinations increased significantly. The percentage of potential LKD who eventually not were approved for donating their kidney was highest in the oldest subgroup above 69 years. One could question whether this time and money consuming screening is justified in the oldest age group.