Accepting living kidney donors with mild hypertension or proteinuria would increase the transplantation rate by only 3%, according to a review of cases from four transplant centers.
But increasing live donor awareness and overcoming immunologic barriers may more successfully mitigate the effects of donor organ shortage in patients who need kidney transplants, Dr. Martin Karpinski of the University of Manitoba, Winnipeg, and his associates wrote (Am. J. Kidney Dis. 2006;47:317–23).
Yet even a 3% increase indicates that the glass is “half full” rather than “half empty,” because transplants increase longevity and improve quality of life, Dr. Arthur J. Matas of the University of Minnesota, Minneapolis, wrote in an editorial (Am. J. Kidney Dis. 2006;47:353–5).
In the study of 352 wait-listed patients with end-stage renal disease, 31 potential living kidney donors were turned down because of hypertension or proteinuria. The researchers identified 12 (3%) donors with acceptable levels of hypertension (untreated blood pressure between 140/90 mm Hg and 150/100 mm Hg or treated with a single antihypertensive medication to less than 140/90 mm Hg) or proteinuria (protein 0.15–0.30 g/day).
Only 124 (35%) of the 352 patients on the wait list had at least 1 potential living donor evaluated. Overall, 180 potential donors for these 124 patients were evaluated and excluded. Positive crossmatch and blood group type incompatibility accounted for 55% of the donor exclusions.
Efforts to make greater use of living donors need not be mutually exclusive, because each of the potential ways of addressing the problem has its own set of issues, Dr. Matas wrote.
“There is no reason why transplant centers could not simultaneously work to increase living donor rates, overcome immunologic barriers, and accept living donors with mild hypertension,” he said.
The long-term effects of these types of kidney transplants are not yet known, nor is it clear whether recipients fare better by continuing with dialysis until a deceased donor kidney is available, Dr. Matas and Dr. Karpinski and his colleagues noted.
A study of 24 white living kidney donors with essential hypertension found no adverse effects of the donation on blood pressure after a mean of 282 days of follow-up (Transplantation 2004;78:276–82). Longer follow-up will be necessary to accept such living donors, Dr. Matas wrote.
Any centers that want to take on these challenges must have systems in place for adequate evaluation, counseling, education, and long-term follow-up of prospective living donors and recipients, he added.