Medical Abnormalities Need Not Exclude Middle-Aged Kidney Donors

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VANCOUVER, B.C.—Middle-aged individuals with isolated medical abnormalities are often acceptable as kidney donors, a researcher said.

In a talk at the 2011 World Congress of Nephrology summarizing the clinic's experience with donors, Stephen Textor, MD, Professor of Medicine at Mayo Clinic in Rochester, Minn., focused on hypertensive living kidney donors with normal kidney function.

Outcomes of white people older than 40 years who donated kidneys at the clinic between 2000 and 2002 showed no deleterious effects of moderate essential hypertension in the first-year post-nephrectomy (Transplantation. 2004;78:276-282). Hypertensive donors experienced a decrease in glomerular filtration rate, he said, but not above the normal decrease associated with aging. There also was no change in urine protein excretion in these individuals.

Dr. Textor and his colleagues have followed the donors for a median of 6.9 years. All of them continue to have their blood pressure (BP) controlled with medication and none have developed end-stage renal disease.

“The workup almost never indicates potential donors are ‘absolutely well'—we always find things and hence we need to take this into account when we define our exclusion criteria,” he said. “And for many of the abnormalities that come up, we think older donors are much better than younger donors because with younger donors you can't really predict what's going to happen to them with respect to hypertension, obesity, etc.”

He presented the case of a woman who came forward as a potential kidney donor for her husband. She was 68 years old and had significant hypertension and a body mass index of 30 kg/m2. Her stress echocardiogram results were normal except for a very large increase in BP.

“For many programs this would be a stopper for moving forward,” Dr. Textor said. “But long-term data now indicate that elevated blood pressure, except among those who are extremely hypertensive, is not further increased appreciably by nephrectomy and can be well-controlled by medication.”

His team accepted the woman as a donor and now, five years later, “she is fine, and her life with her husband is a lot better. She has gained by through going through this evaluation and is getting much better medical control of her blood pressure,” Dr. Textor said.

He and his team age-stratify isolated abnormalities that they uncover in potential donors, such as elevated blood pressure or glucose levels, and consider older donors to be far more predictable regarding the effect of these conditions on their long-term health. They also have not set an age limit for kidney donation, because their data do not support this, Dr. Textor noted.

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