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Perioperative Evaluation and Management of Living Donor Candidates

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Living Kidney Donation

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Abstract

The evaluation and care of living kidney donor candidates must consider and minimize both perioperative and long-term risks for the donor. The comprehensive medical and psychosocial evaluation of living donor candidates is detailed across the chapters in this text. In this chapter, preoperative laboratory and testing recommendations are discussed along with the evidence for screening to reduce cardiac, pulmonary, venous thromboembolism and bleeding complications of donor nephrectomy surgery. Additionally, intraoperative and postoperative management to reduce adverse donor events, maintain high-quality outcomes, and improve efficiency is described. Finally, perioperative complications and expectations for return to predonation function for living kidney donors are reviewed.

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References

  1. Lentine KL, Patel A. Risks and outcomes of living donation. Adv Chronic Kidney Dis. 2012;19(4):220–8. https://doi.org/10.1053/j.ackd.2011.09.005.

  2. 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(Suppl 8S):S1–S109. https://doi.org/10.1097/TP.0000000000001769.

  3. Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA. 2010;303(10):959–66. https://doi.org/10.1001/jama.2010.237.

  4. Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999–2001: a survey of United States transplant centers. Am J Transplant. 2003;3(7):830–4. https://pubmed.ncbi.nlm.nih.gov/12814474/.

  5. Hadjianastassiou VG, Johnson RJ, Rudge CJ, Mamode N. 2509 living donor nephrectomies, morbidity and mortality, including the UK introduction of laparoscopic donor surgery. Am J Transplant. 2007;7(11):2532–7. https://doi.org/10.1111/j.1600-6143.2007.01975.x.

  6. Schold JD, Goldfarb DA, Buccini LD, Rodrigue JR, Mandelbrot DA, Heaphy EL, et al. Comorbidity burden and perioperative complications for living kidney donors in the United States. Clin J Am Soc Nephrol. 2013;8(10):1773–82. https://doi.org/10.2215/CJN.12311212.

  7. Clavien PA, Barkun J, de Oliveira ML, Vauthey JN, Dindo D, Schulick RD, et al. The Clavien-Dindo classification of surgical complications: five-year experience. Ann Surg. 2009;250(2):187–96. https://doi.org/10.1097/SLA.0b013e3181b13ca2.

  8. Lentine KL, Lam NN, Axelrod D, Schnitzler MA, Garg AX, Xiao H, et al. Perioperative complications after living kidney donation: a national study. Am J Transplant. 2016;16(6):1848–57. https://doi.org/10.1111/ajt.13687.

  9. Mjoen G, Oyen O, Holdaas H, Line P. Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry. Transplantation. 2009;88(11):1273–9. https://doi.org/10.1097/TP.0b013e3181bb44fd.

  10. Garcia-Ochoa C, Feldman LS, Nguan C, Monroy-Cuadros M, Arnold J, Boudville N, et al. Perioperative complications during living donor nephrectomy: results from a multicenter cohort study. Can J Kidney Health Dis. 2019;6:2054358119857718. https://doi.org/10.1177/2054358119857718.

  11. Lentine KL, Lam NN, Schnitzler MA, Hess GP, Kasiske BL, Xiao H, et al. Predonation prescription opioid use: a novel risk factor for readmission after living kidney donation. Am J Transplant. 2017;17(3):744–53. https://doi.org/10.1111/ajt.14033.

  12. Organ Procurement and Transplantation Network (OPTN/United Network for Organ Sharing). Policy 14: Living Donation. Available at: https://optn.transplant.hrsa.gov/governance/policies/. Accessed: 7 Sept 2020.

  13. Wilson CH, Sanni A, Rix DA, Soomro NA. Laparoscopic versus open nephrectomy for live kidney donors. Cochrane Database Syst Rev. 2011;(11):CD006124. https://doi.org/10.1002/14651858.CD006124.pub2.

  14. Fleisher LA, Beckman JA, Brown KA, Calkins H, Chaikof EL, Fleischmann KE, et al. ACC/AHA 2007 guidelines on perioperative cardiovascular evaluation and care for noncardiac surgery: a report of the American College of Cardiology/American Heart Association task force on practice guidelines. Circulation. 2007;116:e418–99. https://doi.org/10.1161/CIRCULATIONAHA.107.185699.

  15. Ferket BS, Genders TS, Colkesen EB, Visser JJ, Spronk S, Steyerberg EW, et al. Systemic review of guidelines on imaging of asymptomatic coronary artery disease. J Am Coll Cardiol. 2011;57(15):1591–600. https://doi.org/10.1016/j.jacc.2010.10.055.

  16. Chee YL, Crawford JC, Watson HG, Greaves M. Guidelines on the assessment of bleeding risk prior to surgery or invasive procedures. British Committee for Standards in Haematology. Br J Haematol. 2008;140(5):496–504. https://doi.org/10.1111/j.1365-2141.2007.06968.x.

  17. Devereaux PJ, Mrkobrada M, Sessler DI, Leslie K, Alonso-Coello P, Kurz A, et al. Aspirin in patients undergoing noncardiac surgery. N Engl J Med. 2014;370(16):1494–503. https://doi.org/10.1056/NEJMoa1401105.

  18. Hornor MA, Duane TM, Ehlers AP, Jensen EH, Brown PS, Pohl D, et al. American College of Surgeons’ guidelines for the perioperative management of antithrombotic medication. J Am Coll Surg. 2018;227(5):521–36.e1. https://doi.org/10.1016/j.jamcollsurg.2018.08.183.

  19. Guyatt GH, Akl EA, Crowther M, Gutterman DD, Schuunemann HJ. Executive summary: antithrombotic therapy and prevention of thrombosis, 9th ed: https://doi.org/American College of Chest Physicians evidence-based clinical practice guidelines. Chest. 2012;141(2 Suppl)v:7S–47S.

    Google Scholar 

  20. Qaseem A, Snow V, Fitterman N, Hornbake ER, Lawrence VA, Smetana GW, et al. Risk assessment for and strategies to reduce perioperative pulmonary complications for patients undergoing noncardiothoracic surgery: a guideline from the American College of Physicians. Ann Intern Med. 2006;144(8):575–80. https://doi.org/10.7326/0003-4819-144-8-200604180-00008.

  21. Mills E, Eyawo O, Lockhart I, Kelly S, Wu P, Ebbert JO. Smoking cessation reduces postoperative complications: a systematic review and meta-analysis. Am J Med. 2011;124(2):144–154e.148. https://doi.org/10.1016/j.amjmed.2010.09.013.

  22. Berrios-Torres SI, Umscheid CA, Leas B, Stone EC, Kelz RR, et al. Centers for Disease Control and Prevention guideline for the prevention of surgical site infection, 2017. JAMA Surg. 2017;152(8):784–91. https://doi.org/10.1001/jamasurg.2017.0904.

  23. Forbes RC, King AK, McGrane T, Hale D, Sandberg W, Wanderer J, et al. Enhanced recovery after surgery pathway for living donor neprectomy patients decreases length of stay and narcotic utilization. [abstract]. Am J Transplant. 2017;17(suppl 3):788–9.

    Google Scholar 

  24. Lemmens HJM. Anesthesia for living kidney donors. Avidan M, Brennan DC, editors. UpToDate. Waltham, MA: UpToDate Inc. Available at: https://www.uptodate.com. Accessed: 7 Sept 2020.

  25. Rege A, Leraas H, Vikraman D, Ravindra K, Brennan T, Miller T, et al. Could the use of an enhanced recovery protocol in laparoscopic donor nephrectomy be an incentive for live kidney donation? Cureus. 2016;8(11):e889. https://doi.org/10.7759/cureus.889.

  26. Tiggeler RG, Berden JH, Oitsma AJ, Koene RA. Prevention of acute tubular necrosis in cadaveric kidney transplantation by the combined use of mannitol and moderate hydration. Ann Surg. 1985;201(2):246–51. https://doi.org/10.1097/00000658-198502000-00020.

  27. Albanèse J, Leone M, Garnier F, Bourgoin A, Antonini F, Martin C. Renal effects of norepinephrine in septic and nonseptic patients. Chest. 2004;126(2):534–9. https://doi.org/10.1378/chest.126.2.534.

  28. Joshi GP, Cunningham A. In: Clinical Anesthesia, Barash PG, editors. Anesthesia for laparoscopic and robotic surgeries, vol. 7. Philadelphia: Lippincott Williams Wilkins; 2013. p. 1257–73.

    Google Scholar 

  29. Nanidis TG, Antcliffe D, Kokkinos C, Borysiewicz CA, Darzi AW, Tekkis PP, et al. Laparoscopic versus open live donor nephrectomy in renal transplantation: a meta-analysis. Ann Surg. 2008;247(1):58–70. https://doi.org/10.1097/SLA.0b013e318153fd13.

  30. Kortram K, Ijzermans JN, Frank JM. Perioperative events and complications in minimally invasive live donor nephrectomy: a systematic review and meta-analysis. Transplantation. 2016;100(11):2264–75. https://doi.org/10.1097/TP.0000000000001327.

  31. Waits SA, Hilliard P, Sheetz KH, Sung RS, Englesbe MJ. Building the case for enhanced recovery protocols in living kidney donors. Transplantation. 2015;99:405–8. https://doi.org/10.1097/TP.0000000000000328.

  32. Practice Guidelines for Preoperative Fasting and the Use of Pharmacologic Agents to Reduce the Risk of Pulmonary Aspiration. Application to healthy patients undergoing elective procedures: an updated report by the American Society of Anesthesiologists task force on preoperative fasting and the use of pharmacologic agents to reduce the risk of pulmonary aspiration. Anesthesiology. 2017;126(3):376–93. https://doi.org/10.1097/ALN.0000000000001452.

  33. Campsen J, Call T, Allen CM, Presson AP, Martinez E, Rofaiel G, et al. Prospective, double-blind, randomized clinical trial comparing an ERAS pathway with ketorolac and pregabalin versus standard of care plus placebo during live donor nephrectomy for kidney transplant. 2019;19(6):1777–81. https://doi.org/10.1111/ajt.15242.

  34. Organ Procurement and Transplantation Network (OPTN) / United Network for Organ Sharing (UNOS). Policy 18: Data Submission Requirements. Available at: http://optn.transplant. hrsa.gov/ContentDocuments/OPTN_Policies.pdf. Accessed: 7 Sept 2020.

  35. Dageforde LA, Feurer ID, Moore DE. Longitudinal health-related quality of life, pain, and activity in kidney donors [abstract]. Am J Transplant. 2014;14(suppl 2):68–9.

    Google Scholar 

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Author information

Authors and Affiliations

  1. Division of General Surgery, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Gretchen Edwards

  2. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Beatrice P. Concepcion

  3. Division of Kidney and Pancreas Transplantation, Department of Surgery, Vanderbilt University Medical Center, Nashville, TN, USA

    Rachel C. Forbes

Authors
  1. Gretchen Edwards
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  2. Beatrice P. Concepcion
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  3. Rachel C. Forbes
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Corresponding author

Correspondence to Rachel C. Forbes .

Editor information

Editors and Affiliations

  1. Center for Abdominal Transplantation, Division of Nephrology, Saint Louis University School of Medicine, St. Louis, MO, USA

    Krista L. Lentine

  2. Division of Nephrology and Hypertension, Department of Medicine, Vanderbilt University Medical Center, Nashville, TN, USA

    Beatrice P. Concepcion

  3. Section of Nephrology, Department of Medicine, University of Illinois at Chicago, Chicago, IL, USA

    Edgar V. Lerma

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Edwards, G., Concepcion, B.P., Forbes, R.C. (2021). Perioperative Evaluation and Management of Living Donor Candidates. In: Lentine, K.L., Concepcion, B.P., Lerma, E.V. (eds) Living Kidney Donation. Springer, Cham. https://doi.org/10.1007/978-3-030-53618-3_9

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  • DOI: https://doi.org/10.1007/978-3-030-53618-3_9

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-53617-6

  • Online ISBN: 978-3-030-53618-3

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