POTANSİYEL CANLI BÖBREK VERİCİLERİNİN REDDEDİLME NEDENLERİNİN DEĞERLENDİRİLMESİ: TEK MERKEZ DENEYİMİ

Abstract

Amaç: Böbrek nakli diyaliz tedavisine gore son dönem böbrek yetmezlikli hastalarda daha iyi sonuçlar sağlamaktadır. Canlıdan böbrek nakli ise kadavradan böbrek nakline gore daha iyi hasta ve greft sağ kalımı sağlar. Öte yandan, uzun dönem komplikasyonlar olarak hafif proteinüri, kan basıncında artış, preeklampsi, son dönem böbrek hastalığı ve ölüm hala vericiler için önemli sorunlardır. Bu çalışmada, hastanemizdeki böbrek verici reddedilme nedenlerini değerlendirmeyi amaçladık. Gereç ve Yöntem: Verici adaylarının tıbbi bilgileri retrospektif olarak incelendi. Tarama testleri, cross match testi, doku tiplendirilmesi, rutin kardiyolojik, solunum sistemi, psikiyatrik durumlarının değerlendirilmesi ve gerekliyse kanser taraması yapıldı. Veriler ortalama±standard sapma olarak gösterildi. Bulgular: İki yüz kırkbeş birey verici adayı olarak başvurdu. Bunlardan 118’i donor olamadı. Bunların 21 tanesi tüm değerlendirmeler yapıldıktan sonra verici olmaktan vazgeçti. Kalan 97 bireyin en sık reddedilme nedenleri hipertansiyon, diyabetes mellitus-obezite, glomerular filtrasyon oranında asimetri-parankimal bozukluklar idi. Ayrıca , beş verici adayında kanser tanısı koyduk. Sonuç: Potansiyel böbrek verici adaylarının değerlendirilmesi, ileride çıkabilecek riskleri azaltmak için hayati önem taşımaktadır

Keywords

• Böbrek nakli,canlı böbrek verici adayı,hipertansiyon

EVALUATING THE CAUSES FOR REJECTION OF POTENTIAL LIVE-RENAL DONORS: SINGLE CENTER EXPERIENCE

Abstract

Objective: Renal transplantation provides better outcomes for end stage renal disease patients in comparison to dialysis. Living kidney donation provides better long-term patient and graft survival compared to deceased-donor transplantations. In the long term, complications such as mild proteinuria, an increase in blood pressure, preeclampsia, end stage renal disease and mortality are the main problems for donors. In this study, we aimed to evaluate the causes of kidney donor rejections in our hospital. Material and Method: The medical files of individuals presented as donor candidates were retrospectively examined. Screening tests, cross match test, tissue typing, routine evaluation of cardiologic system, respiratory system, psychiatric condition and cancer screenings, if necessary, were performed as part of the donor candidate work-up. Data was expressed as mean±SD. Results: Two hundred and forty five individuals presented themselves as donor candidates in our hospital. Of these, 118 patients could not be donors. Of these 118 individuals, 21 potential donors were rejected donor despite completing all evaluations. The main causes for rejection of 97 individuals were hypertension, diabetes mellitus-obesity and asymmetry in glomerular filtration rate/parenchymal abnormalities. In addition, we diagnosed cancer in 5 potential donors. Conclusion: Potential kidney donor evaluation is of paramount importance in order to minimize possible risks.

Keywords

• Renal transplantation,living kidney donor candidate,hypertension

References

1. 1. Medin C, Elinder CG, Hylander B, Blom B, Wilczek H. Survival of patients who have been on a waiting list for renal transplantation. Nephrol Dial Transplant 2000;15(5):701-4.
2. 2. Abecassis M, Bartlett ST, Collins AJ, Davis CL, Delmonico FL, Friedewald JJ, et al. Kidney transplantation as primary therapy forend-stage renal disease: a National Kidney Foundation/Kidney Disease Outcomes Quality Initiative (NKF/KDOQITM) conference. Clin J Am Soc Nephrol 2008;3(2):471-80.
3. 3. Reese PP, Boudville N, Garg AX. Living kidney donation: outcomes, ethics, and uncertainty. Lancet 2015;385(9981):2003-13.
4. 4. Horvat LD, Shariff SZ, Garg AX. Donor Nephrectomy Outcomes Research (DONOR) Network. Global trends in the rates of living kidney donation. Kidney Int 2009;75(10):108898.
5. 5. Nurhan Seyahi, Kenan Ateş, Gültekin Süleymanlar. Current Status of Renal Replacement Therapies in Turkey: Turkish Society of Nephrology Registry 2015 Summary Report. TurkNeph Dial Transpl 2017;26(2):154-60.
6. 6. Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017;101(8S Suppl 1):S1-S109.
7. 7. Garg AX, Prasad GV, Thiessen-Philbrook HR, Ping L, Melo M, Gibney EM, et al. Donor Nephrectomy Outcomes Research (DONOR) Network. Cardiovascular disease and hypertension risk in living kidney donors: an analysis of health administrative data in Ontario, Canada. Transplantation 2008;86(3):399-406.
8. 8. Doshi MD, Goggins MO, Li L, Garg AX. Medical outcomes in African American live kidney donors: a matched cohort study. Am J Transplant 2013;13(1):111-8.

9. 9. Mjøen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Øyen O, et al. Long-term risks for kidney donors. Kidney Int 2014;86(1):162-7.
10. 10. Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, et al. Risk of end-stage renal disease following live kidney donation. JAMA 2014;311(6):579-86.
11. 11. Garg AX, McArthur E, Lentine KL. Donor Nephrectomy Outcomes Research (DONOR) Network. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med 2015;372(15):1469-70.
12. 12. Organ Procurement and Transplantation Network (OPTN)/ United Network for Organ Sharing (UNOS). National data reports, transplants by donor type, latest data. Son güncellenme ya da ziyaret tarihi Available from: URL: https://optn.transplant.hrsa.gov/data/view-data-reports/ national-data.
13. 13. Perlis N, Connelly M, D’A Honey JR, Pace KT, Stewart R. Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience. Can Urol Assoc J 2013;7(1-2):41-5.
14. 14. Larsen J, Sorensen SS, Feldt-Rasmussen B. Can value for money be improved by changing the sequence of our donor work-up in the living kidney donor program. Transplant Int 2009;22(8):814-20.
15. 15. Thuesen AD, Carstens J, Weble TC, Baerentsen ID, Thiesson HC, Hansen LU, et al. Living Kidney Donor Evaluation and Rejection: A Danish Single-Centre Experience. J Clin Nephrol Kidney Dis 2018;3(1):1013.
16. 16. Saunders R, Elwell R, Murphy GJ, Horsburgh T, Carr SJ, Nicholson ML. Workload generated by a living donor programme for renal transplantation. Nephrol Dial Transplant 2000;15(10):1667-72.
17. 17. Altun B, Süleymanlar G, Utaş C, Arınsoy T, Ateş K, Ecder T, et al. Prevalence, awareness, treatment and control of hypertension inadults with chronic kidney disease in Turkey: results from the CREDIT study. Kidney Blood Press Res 2012;36(1):36-46.
18. 18. Kronborg CN, Hallas J, Jacobsen IA. Prevalence, awareness, and control of arterial hypertension in Denmark. J Am Soc Hypertens 2009;3(1):19-24.