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61
Living Donation Forum / Re: Does Low GFR Mean CKD in Living Kidney Donors?
« Last post by Michael on July 20, 2023, 11:33:05 AM »
KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5540357/

Kidney Disease: Improving Global Outcomes (KDIGO) is an independent global nonprofit organization that is "developing and implementing evidence-based clinical practice guidelines in kidney disease." KDIGO published clinical guidelines for diagnosing and managing chronic kidney disease (CKD) in 2012. They published guidelines for the evaluation and care of living kidney donors in 2017.

Chapter 19 of the 2017 living donor guidelines provides suggestions for post-donation care. Section 19.3 addresses living kidney donors who are evaluated using the standard measures (from their 2012 guidelines) and determined to have CKD. The recommendation is to treat the donor as any other patient diagnosed with CKD: "Donors should be monitored for CKD, and those meeting criteria for CKD should be managed according to the 2012 KDIGO CKD Guideline." In other words, KDIGO does not recommend treating living donors differently from people with two kidneys when evaluating and diagnosing CKD.
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Living Donation Forum / Re: Does Low GFR Mean CKD in Living Kidney Donors?
« Last post by Michael on July 19, 2023, 03:59:58 PM »
The Unjustified Classification of Kidney Donors as Patients with CKD
https://journals.lww.com/cjasn/pages/articleviewer.aspx?year=2013&issue=08000&article=00019&type=Fulltext#

This articles analyzes several studies of living kidney donors, GFR, and chronic disease that "provides evidence that kidney donors, despite having reduced GFR, are not at increased risk for CKD-associated morbidity and mortality." More specifically, they conclude "kidney donors with low GFR and no other signs of kidney disease should not be classified as having CKD."

This is good news in the sense that a low GFR on its own does not appear to be associated with higher mortality or progression to End Stage Renal Disease (ESRD). But... it leaves open the question of whether there is reason to be concerned if a living kidney donor has BOTH a low GFR and some other sign of kidney disease such as a high level of albuminuria.

The study doesn't come out and say this directly but you could draw these kinds of conclusions:
  • Low GFR only (no other signs of kidney disease), you're probably OK.
  • Low GFR AND other signs of kidney disease for more than three months, you might have chronic kidney disease.

63
Living Donation Forum / Re: Does Low GFR Mean CKD in Living Kidney Donors?
« Last post by Michael on July 19, 2023, 03:27:55 PM »
Low GFR After Kidney Donation is Not Chronic Kidney Disease
https://atcmeetingabstracts.com/abstract/low-gfr-after-kidney-donation-is-not-chronic-kidney-disease/

Only an abstract of this study is available. They followed a fairly small group of living kidney donors and non-donor patients with chronic kidney disease. They measured kidney health using GFR at the start of the project and again about five years later. The GFR improved for donors and worsened for non-donor CKD patients. They concluded  that "former kidney donors show a substantially different course in kidney function than CKD patients. Even though many kidney donors have a low GFR early post-donation, these healthy individuals should not be regarded as CKD patients. CKD criteria are not suitable for former kidney donors."

(Personally, I would like to see a study with a larger number of participants and a longer period over which the GFRs of donors and non-donors are compared.)
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Living Donation Forum / Does Low GFR Mean CKD in Living Kidney Donors?
« Last post by Michael on July 19, 2023, 03:16:55 PM »
The debate of how to assess the health of the remaining kidney of a living donor has been going on for decades, and there doesn't appear to be any signs of resolution. The issue: does a low glomerular filtration rate (GFR) mean you have chronic kidney disease (CKD) if you are a living donor?

The answer matters because being told you have CKD can lead to stress and anxiety, and it can lead to changes in your lifestyle (diet, exercise, etc.) and even to a loss of insurability. The question comes up in the first place because the measures of kidney health used to determine if a patient has CKD are based on individuals with two kidneys. Should those same measures and standards be used for living kidney donors?

The short answer is "we don't know." The medical community so far has been unwilling to publish guidelines for assessing kidney health that are tailored to living donors. That leaves living donors without a clear idea of what some of these kidney health measures like GFR really mean for them.

The purpose of this message is to keep track of discussions of this topic as they occur so we have a place to go to be current on the subject.



65
Living Donation in the News / Video: Living kidney donor keeps on rolling
« Last post by Clark on July 18, 2023, 10:49:28 AM »
https://www.wsaw.com/video/2023/07/15/living-kidney-donor-keeps-rolling/

[/size]Living kidney donor keeps on rolling
66
Living Donation in the News / High school teacher getting ready to donate kidney to student
« Last post by Clark on July 18, 2023, 10:45:36 AM »
https://www.goodmorningamerica.com/living/story/high-school-teacher-ready-donate-kidney-student-101231142

High school teacher getting ready to donate kidney to student

By Yi-Jin Yu

An Ohio math teacher is getting ready to donate a kidney to one of his high school students next week.
Eddie McCarthy, a math teacher at Whitmer High School in Toledo, Ohio, taught Roman McCormick geometry last school year, but he's going to give Roman more than just skills for life: Roman's parents hope one of McCarthy's kidneys will give the 15-year-old "his teenage years back."

Roman, a high school sophomore, has branchiootorenal or BOR syndrome, a rare, hereditary condition that affects tissue development and can cause ear and kidney malformations, according to the National Institutes of Health.

"I'm not able to eat foods that most normal kids will be able to. I'm not able to be more [physically] active because [my] kidneys are slowing down my physical activity," Roman told "Good Morning America," adding that his condition often makes him feel very tired as well.

Jamie Redd, Roman's mother, explained, "It's spelled B-O-R and you can have the B, the O or the R. With Roman, he has the B and the R. We didn't know that his father had it until Roman was diagnosed with it. And then his father had a kidney transplant [last year]. They both had the R, which is 'renal' … The B is for 'branchio', so like, [Roman] had a hole in his chest and two holes in the sides of his ears. They were like divot size holes in the sides of his ears that he had surgery at 6 months to correct and fix."

Over time, Roman's BOR syndrome worsened and led to stage 4 kidney disease, and it appeared he would need to go on dialysis if he couldn't find a donor and get a kidney transplant.

Redd and Roman's father Dan McCormick decided to reach out for outside help in February, first telling Roman's story through a local news article with The Monroe News in Monroe, Michigan, about 21 miles north of Toledo, and then later through local TV news, including with Toledo ABC affiliate WTVG.

"That story was pretty much our cry for help to get a donor, to get people to want to donate, to be live donors," Redd said, adding that they had been searching for a live donor for Roman for nearly two years. "Our goal was to get a live donor because a kidney from a live donor will last longer than from a deceased donor.”

McCarthy ended up seeing Roman's story five months ago and said he didn't dwell on it too much, but within a couple of days, he called and went to get tested to see if he could help.
"In mid-February, I think the story was just going around, maybe on Facebook or something and maybe one of my friends might have texted me like, 'Hey, this is your student.' So I saw that," McCarthy recounted. "And then the next day, or maybe a day after that, I went and got tested. We were matched there and then I just kept going back up to the hospital and doing all the tests that you have to do, and I kept coming back healthy, and it was shown that I'm a match for him."
For the kidney donation, McCarthy and Roman would have to share the same blood type -- in this case, O positive -- and other steps had to be followed for it all to work out.
"When I originally signed up, you don't go into it thinking, 'I'm gonna donate my kidney.' You just go into it thinking, 'Let's see if we're a match. Let's see if it works.'" McCarthy said. "And then it just worked. And it's pretty crazy that it ends up being, you know, like his math teacher … because I know there were a bunch of other people that probably started the process as well. But you know, you got to be a match. It doesn't always work out."

The donation and transplant surgeries will take place July 19 at the University of Michigan University Hospital in Ann Arbor, about an hour away from Toledo.
Both Dan McCormick and Redd said they are immensely grateful to McCarthy for his selfless act for their son.

"The fact that my son was able to get a donor just means the world to me," McCormick said. "I'll never be able to … thank him enough for everything that he's done for us. He's a wonderful human being."
Redd added, "I was just so speechless … I could thank him for the rest of my life and it would still never be enough for what he's doing. And I know it's a commitment not just from him, but his family too."
As a parent himself, McCarthy said he has tried to put himself in McCormick and Redd's shoes and now is "just very excited" to help Roman.

"There's people out there who need kidneys … You technically don't need both of yours. So, why not help someone who really really needs it?" McCarthy said. "It's totally worth it to just go for it. Go get checked out and see if you're a match."
Redd added she hopes Roman's story will encourage other families who may also be going through a tough time with their kids.
"My message would be to never give up, to always advocate for your child, to keep pushing. I know there were times where we felt like we were on a roller coaster," Redd said.
She added, "My [other] message would be to get checked, because you can be a live donor for someone and help. You don't just have to be that mark on your driver's license, saying, 'I'm an organ donor.' You can help someone right now, while you're here."
67
Living Donation in the News / I donated a kidney to a stranger because life is good and good to share
« Last post by Clark on July 18, 2023, 10:30:08 AM »
https://www.theglobeandmail.com/life/first-person/article-i-donated-a-kidney-to-a-stranger-because-life-is-good-and-good-to/

I donated a kidney to a stranger because life is good and good to share
KATHY SYKORA
CONTRIBUTED TO THE GLOBE AND MAIL
PUBLISHED JULY 16, 2023

First Person is a daily personal piece submitted by readers. Have a story to tell? See our guidelines at tgam.ca/essayguide.
I am what you call a late bloomer. I learned to ride a bike in my 20s; I learned to read Hebrew in my 40s; I learned to swim when I turned 60. Then, as I was pushing 70, I decided to become a living kidney donor.
The idea wasn’t completely far-fetched. I’d become a blood donor as soon as I was old enough, and I was on the stem cell donation list for decades. I always knew that if someone close to me needed a transplant, I’d volunteer at the drop of a hat. But this never came up.
Then one day my synagogue sent an appeal for someone in need of a kidney. I had never met this man and I only barely knew the family. But I couldn’t help but think: Why don’t I donate?
I spoke with my husband, who is the more measured of the two of us. We stepped back for a few weeks – to let the idea sink in, to search inside our hearts and to educate ourselves on the topic. Did you know, for example, that the left kidney sits higher in the body than the right one? Or that the transplant recipient typically retains their kidneys, and the new one is placed in their groin? Or that the donor’s remaining kidney grows by 50 per cent in the year after donation? I read everything – from heartfelt testimonials to medical articles way over my head, from dry official statistics to rambling Facebook posts, and lots more about the testing, the procedure, the recovery and of course the risks. And every time I read about living kidney donations, I thought – wouldn’t it be amazing to be able to do that?
Was it impulsive? Possibly. But most people regret what they have not done much more than they ever regret the things they have done.
It soon became clear that I would not be able to donate directly to the man that the original appeal was for. But, if I would consider doing this for a near stranger, then why not for a complete stranger?
There are different paths to kidney donation. Some people donate to someone close to them, or to someone they have a more tenuous connection with. Others find ways to seek out and meet a potential recipient. A somewhat different approach is to make an undirected donation to an unknown recipient. In Ontario, where I live, an undirected donation must always remain anonymous.
Deciding between finding a recipient and making an undirected donation was not easy. Eventually, I concluded that registering as an anonymous undirected donor was most consistent with my values. I had hoped to enable a chain of donations through the Canadian Blood Services Kidney Paired Donation program, but, to my surprise, they could not find me a match there. And that’s how I ended up signing up to donate to the person on the waiting list that needed me most.
The thorough testing that donors undergo took the better part of a year. Doctors tested my general health and my kidney health; they tested my cardiovascular health and my mental health; and occasionally they tested my patience! Every one of these tests yielded the same conclusion: I was ridiculously healthy and okay to donate.
Outside of testing, there was little to do to prepare. I increased my exercise routine to help with post-op recovery. I learned to sleep on my back, since sleeping on my side right after having my kidney removed did not seem like the best idea. I attempted to learn to meditate, anticipating both anxiety and a certain amount of discomfort. Newsflash! Meditation is not my strong suit.
The donor surgery is a three-and-a-half-hour laparoscopic affair, with one longer incision for taking the kidney out. The surgery is safe; but naturally, there are always risks. The likelihood of the most serious risks is so minuscule, it is similar to risks we take all the time. But there is definitely a recovery period, and it is hard to predict how any one donor will fare. All in all, donating an organ is not a decision to be taken lightly and the support of family and friends is paramount.
My surgery was followed by four days in the hospital. Then from the moment I came home, I was pampered by my husband, watched over by our Golden Retriever and called, texted and visited by friends and family. I watched in awe as the healing process unfolded. The body heals from the inside out. First, your innards rearrange themselves to fill the kidney-sized hole that was left behind, and your bowels slowly recover from being moved around to accommodate the surgery. Then the swelling on your abdomen starts to subside and your incisions continue to heal. Every day I was able to do something that was out of my reach the day before: Put on my own socks, then clear my own dinner plate, then go for a longer walk. Three weeks after surgery, I was completely off any pain medication. I still napped a lot, but otherwise did things closer and closer to normal.
The hardest question people ask me is: “Why?” In fact, this was one of the first items on the 12-page form I needed to fill out prior to entering the program. At that time, I thought, “Oh it’s just a form, let me just put in whatever so I can get to the meaty questions, like my health history and blood type.” So, I put down “To help improve someone’s life.” But now, more than a year and much soul-searching later, I don’t have a better answer. Perhaps I’d add that life is good and good to share.
I wish I was a brilliant physician and able to discover cures for many diseases, eliminating the need for transplants. Or a genius biomedical engineer, able to find a process to 3-D print new organs for anyone who needs one. Or an inspiring fundraiser to enable accelerated research in those areas. The truth is, I am not any of those. And I will surely never run into a burning building to save the life of a child. But this – submitting to an uncomfortable but safe procedure to share a bit of my good health and one superfluous little organ with someone who needs it way more than I do – this was something I could do.
Kathy Sykora lives in Toronto.
68
Living Donation in the News / Hypertension in Living Kidney Donors Ups Proteinuria Risk
« Last post by Clark on July 13, 2023, 01:25:06 PM »
https://www.renalandurologynews.com/home/conference-highlights/era-edta-congress/hypertension-in-living-kidney-donors-ups-proteinuria-risk/

Hypertension in Living Kidney Donors Ups Proteinuria Risk
Natasha Persaud

Hypertension in living kidney donors increases the risk for proteinuria, investigators reported at the 60th European Renal Association Congress in Milan, Italy.
Using the Korean Organ Transplantation Registry (KOTRY), investigators identified 642 hypertensive and 4848 normotensive living kidney donors. Hypertensive donors had a significant 1.8-fold increased risk for proteinuria compared with normotensive donors, Hyeon Seok Hwang, MD, of Severance Hospital, Yonsei University College of Medicine, and colleagues reported. Proteinuria risk tended to increase even after 4-5 years, they noted.
Both before and after nephrectomy, hypertensive living donors had lower estimated glomerular filtration rates (eGFR) than normotensive donors. They had no greater risk of developing chronic kidney disease, however. The risk of eGFR falling below 60 or 45 mL/min/1.73 m2 did not differ significantly between groups.
“Careful monitoring for proteinuria is required in hypertensive donors after nephrectomy,” Dr Hwang’s team concluded.
Reference
Kim JH, Lee YH, Yoon SY, et al. Comparisons of clinical outcomes between hypertensive and normotensive living kidney donors: a nationwide prospective cohort study. Presented at: ERA 2023 Congress; June 15-18; Milan, Italy. Poster 4343.
69
Living Donation in the News / Improving Surgical Safety in Living Donor Renal Transplantation With "ABCDE"
« Last post by Clark on July 13, 2023, 01:23:14 PM »
https://www.cureus.com/articles/168113-improving-surgical-safety-in-living-donor-renal-transplantation-with-antiseptic-skin-preparation-bladder-irrigation-corner-saving-vascular-anastomosis-dj-stenting-and-extravesical-ureteroneocystostomy-modifications-a-comprehensive-approach#!/

Singh S, Wani M S, Bhat A H, et al. (July 10, 2023) Improving Surgical Safety in Living Donor Renal Transplantation With Antiseptic Skin Preparation, Bladder Irrigation, Corner-Saving Vascular Anastomosis, DJ Stenting, and Extravesical Ureteroneocystostomy Modifications: A Comprehensive Approach. Cureus 15(7): e41635. doi:10.7759/cureus.41635

Abstract
Introduction
The antiseptic skin preparation, bladder irrigation, corner-saving vascular anastomosis, DJ stenting, and extravesical ureteroneocystostomy (ABCDE) approach encompasses a range of modifications applied during different stages of the surgical procedure in renal transplantation. These modifications include the following: A, antiseptic skin preparation sequentially with cetrimide 3.35%, chlorhexidine scrub 4%, spirit, and povidone-iodine 10%; B, bladder irrigation with amikacin and betadine solution; C, corner-saving end-to-side vascular anastomosis; D, DJ stenting with early postoperative removal within three weeks; and E, extravesical ureteroneocystostomy using our institute's modified Lich-Gregoir technique.
Methods
This prospective observational study was conducted at our institution between March 2021 and May 2023. Data were collected from the patients' medical records and analyzed using Statistical Package for the Social Sciences (SPSS) (IBM SPSS Statistics, Armonk, NY, USA). Statistical tests, including t-test, Mann-Whitney test, chi-square test, and Fisher's exact test, were used for analysis. The study assessed various recipient, donor, intraoperative, and post-transplant factors, as well as surgical complications and stent-related factors.
Results
Out of 72 renal transplantations, 12 (16.6%) had the following surgical complications: urinary (n = 4; 5.5%), wound-related (n = 3; 4.1%), and lymphocele (n = 5; 6.9%). The most common complications were lymphocele (n = 5; 6.9%) and urinary leak (n = 4; 5.5%). Surgical complications were more common in male recipients (91.6% versus 8.3%), as well as in recipients with longer dialysis duration (24 ± 17 versus 11.0 ± 7 months) and had extended hospitalization time (16.4 ± 8.6 versus 8.0 ± 2.9 days) (p < 0.05). Wound infection correlated with longer surgeries (>300 minutes) and other complications. Lymphocele patients had higher drain output (>500 mL) on day 1 and longer hospital stays (>15 days). Urinary tract infections (UTIs) were linked to dialysis duration (>24 months), diabetes, and longer indwelling times of DJ stents and urinary catheters. Early DJ stent removal (<3 weeks) reduced UTI incidence and symptoms (p < 0.05). All complications were categorized as minor (3a or less), according to the Clavien-Dindo classification.
Conclusion
The modified ABCDE surgical approach in renal transplantation decreased the complications, showing favorable outcomes compared to those in the literature.
70
Living Donation in the News / Virginia law requiring companies to give employees time off to donate organs
« Last post by Clark on July 13, 2023, 12:36:44 PM »
https://www.wavy.com/news/virginia-law-requiring-companies-to-give-employees-time-off-to-donate-organs-takes-effect-july-1/

Virginia law requiring companies to give employees time off to donate organs takes effect July 1
by: Tyler Englander

A new law is set to go into effect in Virginia with the hopes of convincing more people to donate organs.
The law will require employers with over 50 employees to give employees 60 days off unpaid if they donate an organ or 30 days unpaid if they donate bone marrow.
According to Donate Life Virginia, 2,400 Virginians are awaiting a life-saving organ donation.
Lara Malbon, Executive Director of Donate Life Virginia, said live donors can donate a kidney or part of their liver.
“Most people waiting are Virginians in need of a kidney,” Malbon said. “We all have the opportunity right now and living donors to donate a kidney.”
David Bruno, interim chair of the Transplant Department at VCU Health Hume-Lee Transplant Center, said last year that the department did around 500 kidney and liver transplants.
“When I’m talking to family members about encouraging their friends and family members to be donors, they often will kind of dig through a list and say, ‘He’s working, or he’s the only person in the house working,” Bruno said.
Bruno added that time off is needed to travel to appointments before the transplant and to recover.
“It really helps you heal faster, so instead of 9-12 weeks of recovery, you are looking at 6-8 weeks of recovery, and that’s for a strenuous job,” said Bruno.
Bruno added that although some non-profit organizations do pay organ donors for the time they take off, if lawmakers really wanted to make a difference, they would mandate paid time off.
“We don’t want to burden them with a financial disincentive to donate,” said Bruno. “We want to encourage this.”
To be eligible, donors must have worked at that company for at least a year and provide written documentation from a doctor.
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