tx: donor evaluation

Question 1

what is the option for high immunological risk pair?

Answer 1

1. desensatization protocol
2. explore on next donor
3. paired kidney exchange
4. wait for compatible deceased donor

Question 2

in what condition, donor with kidney stone cant donate?

Answer 2

1. had bilateral stone
2. cystine renal stone
3. h/o stone related infection (esp struvite)
4. significant and non corrected metabolic abN

Question 3

can donor with ADPKD donate the kidney?

Answer 3

Cant!

Question 4

can donor with FH of ADPKD donate the kidney?

Answer 4

can - provided radiologically / genetically not fulfill diagnosis of ADPKD

(3 total / 2 uni / 4 uni)

Question 5

Can DM patient be a kidney donor?

Answer 5

can
UNLESS
1. presence of TOD
2. unacceptable lifetime risk of cx

Question 6

what is the criteria to accept DM pt as kidney donor?

Answer 6

1. good control (HbA1c < 7% within 2 yrs x 3 occasions)
2. age > 55 y/o
3. BMI < 30
4. on < 2 OHA
5. no other comorbids
6. Type 2 DM
7. no evidence of TOD
8. UACR < 30mg/g (A1)

Question 7

criteria for HPT pt to be a kidney donor?

Answer 7

1. no TOD
2. well controlled BP
3. < 2 anti hpt

Question 8

ABPM interpretation

Answer 8

mean awake : 135/85
mean asleep: 120/70
average: 130/80

Question 9

evaluation for Hep B pt for donation?

Answer 9

1. HbS Ag +ve, HBV DNA -ve
2. HbS A -ve, HbCAb +ve, HBV DNA -ve

Question 10

What is the risk of related to Hep B donor?

Answer 10

risk of transmision - low
risk of Hep B related GN - 5%

Question 11

what is the long term risk to kidney donor?

Answer 11

1. deterioration of kidney function ~ 0.3% in 15 yrs
2. ESRF ~ 0.5%
3. increase BP - not signifcant to increase HPT prevalence
4. proteinuria - not significant
5. child bearing age: prenancy with risk of PE / PIH – risk of DM/ HPT later

Question 12

pre donation kidney assessment

Answer 12

1. family hx of familial kidney disease
2. donor kidney function = GFR / CrCl (not serum creatinine) ~ mL/min/1.73m2
3. or DTPA / EDTA
4. differential from DTPA (< 10% diff)
   (age related)
   **5. 24hrs urine creat clearance x 3 > 80ml/min/1.73m2 (Mal CPG) **
5. Albuminuria:
   - Urine excretion rate < 30mg/day
   - Urine ACR: <3mg/mmol
   - Urine pt: < 150mg/day
   - Urine PCR < 15mg/mmol
6. hematuria: rbc < 3 rbc/hpf
7. evaluation for stones ( se Ca/Po3, UA/ urine ca, pO4, UA, cystine,stone panel - oxalate etc)

Question 13

what is the assessment for infection transmission

Answer 13

1. HIV / hep B/ C
2. TORCHES (igG) - VZV / CMV
3. TB quantiferon

Question 14

how about the smoking status of the smoker?

Answer 14

1. active smoker - not eligible
2. stop smoking - at least 6/52

Question 15

What is issues with obese donor?

Answer 15

(eligibility BMI < 30)

1. poor wound healing
2. surgical difficulties / morbidities
3. higher risk to develop DM and sequalae of DKD
4. risk of obesity related glomerulopathy
5. risk of CV risk