P1697MULTI- NATIONAL SURVEY AMONG NEPHROLOGISTS AND TRANSPLANT SURGEONS ABOUT THE SUITABILITY AND ACCEPTABILITY OF MARGINAL LIVE KIDNEY DONORS WITH OBESITY OR ABNORMAL BLOOD SUGAR PROFILE
Authors: Arabi Ziad , Bukhari Mohammad 
Published: June 2020

Abstract

Background and Aims
There are no clear guidelines about the suitability and acceptance of living- kidney donors with obesity or abnormal blood sugar profile.

Method
To form a consensus about the acceptance of these donors, a survey was distributed to nephrologists and transplant surgeons in different countries and through AST and ERA-EDTA.

Results
Of a total of (n=122) respondents from 22 countries: 80% (N= 96) were nephrologists and 20% (N=23) were transplant surgeons. The majority were heavily involved in pre-transplant evaluations of donors and recipients and have &gt; 6 years in practice. 75% of the respondents will accept obese donors (BMI 30-35) if donors show some weight loss before donation or at least show commitment to lose weight in the future. However, the presence of a strong family history of diabetes ( DM) in obese donors (even with normal fasting blood sugar (FBS) and hemoglobin A1C [ Hgb A1C]) mandates weight lose preferably to BMI of 30 ( n=46, 38% ) or at least to lose some weight before being considered for donation (n=30, 25%). On the other hand, morbidly obese donors (BMI 36-40) with normal FBS, Hgb A1C and negative family history of DM thought to need to decrease their weight to BMI 30 ( 47% of the respondents) or at least lose some weight before being considered for donation ( n=30, 25%). However, 22% of the respondents would decline these donors due to the risk of relapse of obesity. If an obese donor started to have impaired fasting blood sugar ( IFG), the majority (47%) will decline him/her because of the higher risk to develop DM. (33%) will delay the donation till BMI reaches below 30 and IFG is resolved as a result of weight reduction. Most of the respondents (52%) will not rely solely on isolated mildly elevated Hgb A1C (e.g. Hgb A1C = 5.7- 6) or isolated (IFG) as the critical indicator to decline a young donor with normal weight and normal FBS. Instead 2hrs- glucose tolerance test will be indicated. The presence of even mild and controlled diabetes in a middle age (e.g. 55 years old donor) thought to be a contraindication for kidney donation in 62% of the respondents. However, such donors might be allowed to donate if no alternative donor is available after clearly explaining the risks (23%). In regard to resolved DM after bariatric surgery and weight loss, 43% of the respondents said they will consider them for donation if two years passed after bariatric surgery without obesity relapse (43%). Up to one forth may consider these donors earlier (once BMI is below 30). Despite the surgical difficulties related to obesity in kidney donors, transplant surgeons seem more likely than nephrologists to accept obese donors (P= 0.046), morbidly obese ( P=NS).

Conclusion
Living kidney donors with isolated obesity, (IFG), mildly abnormal HgbA1C or history of bariatric surgery are still considered for kidney donation by many centers. However, donors with more than one abnormality especially at young age are not considered for donation.