Retrospective Cohort Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Transplant. Sep 18, 2023; 13(5): 276-289
Published online Sep 18, 2023. doi: 10.5500/wjt.v13.i5.276
Reasons and effects of the decline of willing related potential living kidney donors
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Nasreldin Mohammed, Ahmed Reda, Nashwa Mostafa Azoz, Mohammed Ali Zarzour, Hisham Mokhtar Hammouda, Mahmoud Khalil
Rabea Ahmed Gadelkareem, Amr Mostafa Abdelgawad, Nasreldin Mohammed, Ahmed Reda, Mohammed Ali Zarzour, Hisham Mokhtar Hammouda, Mahmoud Khalil, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Nashwa Mostafa Azoz, Department of Internal Medicine-Nephrology Unit, Assiut University Hospital, Faculty of Medicine, Assiut University, Assiut 71515, Egypt
Author contributions: Gadelkareem RA, Abdelgawad AM, and Mohammed N designed the research, collected the data, and wrote the paper; Reda A, Azoz NM, and Zarzour MA contributed to statistical analysis, literature review, writing, and revision; Hammouda HM and Khalil M contributed to the literature review, writing, revision, and supervision of the work; All authors approved the paper.
Institutional review board statement: This study was conducted as part of a research project on the outcomes of living donor kidney transplantation performed in our center (Approval No. 17200148/2017).
Informed consent statement: This article is a retrospective study. Hence, the patients were not required to give informed consent to the study because the manipulated data were anonymous and were obtained after each patient, with their potential kidney donor(s), agreed to the plan of management.
Conflict-of-interest statement: The authors have no financial relationships to disclose.
Data sharing statement: The data supporting this study are available from the corresponding author on reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
Corresponding author: Rabea Ahmed Gadelkareem, MD, Assistant Professor, Department of Urology, Assiut Urology and Nephrology Hospital, Faculty of Medicine, Assiut University, Elgamaa Street, Assiut 71515, Egypt.
Received: July 13, 2023
Peer-review started: July 13, 2023
First decision: August 4, 2023
Revised: August 6, 2023
Accepted: August 25, 2023
Article in press: August 25, 2023
Published online: September 18, 2023
Research background

The evaluation protocols for living kidney donor (LD) selection are usually strict but remain a safeguard against violations of LD safety. Hence, the decline of willing potential living donors (PLDs) may occur at any stage of evaluation due to different causes, resulting in variable rates of decline of PLDs.

Research motivation

The rate of decline of willing related LDs seems to be a modifiable variable for improving LD kidney transplantation (LDKT).

Research objectives

To identify the causes of the decline of PLDs, the predictors of PLD candidacy, and the effect on achieving LDKT.

Research methods

A retrospective study was performed on willing PLDs who attended our outpatient clinic for kidney donation to their related potential recipients between October 2015 and December 2022. Two groups of PLDs were compared: Candidate PLDs after a completed evaluation vs non-candidate PLDs with a complete or incomplete evaluation. A multivariate logistic regression was performed to assess the factors contributing to the achievement of PLD candidacy.

Research results

Of 321 willing PLDs, 257 (80.1%) accessed the evaluation to variable extents for 212 potential recipients, with a mean age (range) of 40.5 ± 10.4 (18-65) years. The remaining 64 PLDs (19.9%) did not access the evaluation due to serving as alternatives to essential PLDs, financial causes, and patient-related factors. Only 58 PLDs (18.1%) achieved donation, but 199 PDLs (62.0%) were declined. Exclusion occurred in 144 PLDs (56%) for immunological causes (37.5%), medical causes (54.9%), combined causes (9.7%), and financial causes (2.1%), but regression and release occurred in 55 PLDs (17.1%). The number of potential recipients with candidate PLDs was not significantly different from that with non-candidate PLDs, except in age (P = 0.041), rates of completed evaluation, and exclusion of PLDs (P < 0.001). In the multivariate analysis, there were no independent factors that influenced the rate of PLD candidacy. Most patients who failed to have KT after the decline of their PLDs remained on hemodialysis for 6 mo to 6 years.

Research conclusions

Despite the availability of willing related PLDs for most potential recipients, their rate of decline was high. The causes were various, including medical or immunological contraindications, release, and regression of PLDs. Hence, the chances of LDKT were reduced or lost in a high percentage of potential recipients.

Research perspectives

Trials to reduce the rate of decline of PLDs should not be at the expense of LD safety. However, revision and identification of the causes of PLD decline may help increase the chances of patients for KT, especially with the application of strategies that overcome the immunological barriers of LDKT and low medical literacy.