Events - ISN-TTS Webinar: Evaluation and management of high-risk living kidney donors

Kidney transplantation (KT) is the best treatment for kidney failure. The outcomes of kidney transplants from living donors are better than those from deceased donors, leading to an increase in transplant numbers in many areas where there are fewer deceased donors. The number of living organ donors who are obese and have metabolic disease is increasing globally. They are at risk of developing diabetes, hypertension, cardiovascular diseases, and chronic kidney disease just like the general population. They are also at risk of complications during the surgery, including wound dehiscence and prolonged hospital stays. In addition, the long-term relative risk of cardiovascular and kidney disease increases after donation, although the absolute risk of end-stage kidney disease may be low. Concerns about the link between obesity and adverse health effects have restricted access to overweight kidney donor candidates for kidney donation. In fact, many transplant centers set the criteria of body mass index (BMI) for exclusion of donor candidacy although BMI may not be perfect in reflecting fat mass and define metabolic risk. As a result, BMI should be considered together with all other metabolic factors in assessing long-term risk. In addition, these donors need to be educated about the clear benefits of maintaining a healthy weight and weight loss through long-term lifestyle changes before they donate. Pharmacotherapy including GLP-1 agonists may be used in these donors with some success. Bariatric surgery may be an option, in severely obese adults who fail conventional weight management, for sustained weight loss and may alter donation candidacy in potential donors. All of these approaches could increase the donor pool and improve their health in the long run. The candidates who have experienced significant weight loss from these treatments may be allowed to donate. There has been an increasing number of robotic assisted laparoscopic donor nephrectomy in these obese donors for greater precision, comfort and less wound complication. Finally, long-term follow-up after transplantation is important for monitoring metabolic risks, including weight gain and interventions to prevent cardiorenal complications, as well as mortality.