Medical evaluation of living kidney donors with nephrolithiasis: a survey of practices in the United States

  • V. S. TatapudiEmail author
  • F. Modersitzki
  • S. Marineci
  • M. A. Josephson
  • D. S. Goldfarb
Original article



A scarcity of organs has driven the transplant community to broaden selection criteria for both living and deceased donors. Living donor transplants offer better patient and allograft survival when compared with deceased donor transplants. Many transplant centers now allow complex living donors such as those with nephrolithiasis to undergo nephrectomy.


We conducted a survey of medical and surgical directors of kidney transplant programs in the United States to shed light on current practices pertaining to medical evaluation of living kidney donors with nephrolithiasis. 353 surveys were e-mailed to medical directors and surgical directors of transplant programs after contacts were obtained from UNOS.


49 completed surveys were returned (13.9%). 77.7% (38/49) of survey participants said their centers will consider living kidney donor candidates with a history of symptomatic kidney stones, 69.4% (34/49) said their centers will consider candidates who are incidentally found to have kidney stones and 10.2% (5/49) said their centers decline all potential donors with nephrolithiasis.


Several programs are still reluctant to allow potential donors with nephrolithiasis to donate. There is an unmet need to develop evidence-based guidelines to optimize outcomes in this population of kidney donors with nephrolithiasis and their recipients.


Calculi Renal Kidney transplantation Kidney donor Donor nephrectomy Nephrolithiasis Graft failure Living kidney donor Urolithiasis 


Compliance with ethical standards

Conflict of interest

Dr. Goldfarb: consultant, Allena, Alnylam, AstraZeneca, Retrophin; owner, patent holder: Dr. Arnies. Mr. Modersitzki: consultant, Retrophin. Authors Vasishta S. Tatapudi, Silviana Marineci, and Michelle A. Josephson have declared that no conflict of interest exists.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee at New York University (NYU) Langone Health (IRB approval number s16-00224) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

10157_2019_1814_MOESM1_ESM.pdf (276 kb)
Supplementary material 1 (PDF 277 kb)


  1. 1.
    Tatapudi VS, Montgomery RA. Therapeutic modulation of the complement system in kidney transplantation: clinical indications and emerging drug leads. Front Immunol. 2019;10:2306. CrossRefPubMedPubMedCentralGoogle Scholar
  2. 2.
    El-Zoghby ZM, Stegall MD, Lager DJ, Kremers WK, Amer H, Gloor JM, et al. Identifying specific causes of kidney allograft loss. Am J Transplant. 2009;9(3):527–35.CrossRefGoogle Scholar
  3. 3.
    Evans RW, Manninen DL, Garrison LP Jr, Hart LG, Blagg CR, Gutman RA, et al. The quality of life of patients with end-stage renal disease. N Engl J Med. 1985;312(9):553–9.CrossRefGoogle Scholar
  4. 4.
    Schnuelle P, Lorenz D, Trede M, Van Der Woude FJ. Impact of renal cadaveric transplantation on survival in end-stage renal failure: evidence for reduced mortality risk compared with hemodialysis during long-term follow-up. J Am Soc Nephrol. 1998;9(11):2135–41.PubMedGoogle Scholar
  5. 5.
    Wolfe RA, Ashby VB, Milford EL, Ojo AO, Ettenger RE, Agodoa LY, et al. Comparison of mortality in all patients on dialysis, patients on dialysis awaiting transplantation, and recipients of a first cadaveric transplant. N Engl J Med. 1999;341(23):1725–30.CrossRefGoogle Scholar
  6. 6.
    Maggiore U, Cravedi P. The marginal kidney donor. Curr Opin Organ Transplant. 2014;19(4):372–80.CrossRefGoogle Scholar
  7. 7.
    Reese PP, Caplan AL, Kesselheim AS, Bloom RD. Creating a medical, ethical, and legal framework for complex living kidney donors. Clin J Am Soc Nephrol. 2006;1(6):1148–53.CrossRefGoogle Scholar
  8. 8.
    Delmonico F. A report of the amsterdam forum on the care of the live kidney donor: data and medical guidelines. Transplantation. 2005;79(6 Suppl):S53–S66.PubMedGoogle Scholar
  9. 9.
    Scales CD Jr, Smith AC, Hanley JM, Saigal CS. Prevalence of kidney stones in the United States. Eur Urol. 2012;62(1):160–5.CrossRefGoogle Scholar
  10. 10.
    Strang AM, Lockhart ME, Amling CL, Kolettis PN, Burns JR. Living renal donor allograft lithiasis: a review of stone related morbidity in donors and recipients. J Urol. 2008;179(3):832–6.CrossRefGoogle Scholar
  11. 11.
    Kasiske BL, Ravenscraft M, Ramos EL, Gaston RS, Bia MJ, Danovitch GM. The evaluation of living renal transplant donors: clinical practice guidelines. Ad hoc clinical practice guidelines subcommittee of the patient care and education committee of the American Society of Transplant Physicians. J Am Soc Nephrol. 1996;7(11):2288–313.PubMedGoogle Scholar
  12. 12.
    Strang AM, Lockhart ME, Kenney PJ, Amling CL, Urban DA, El-Galley R, et al. Computerized tomographic angiography for renal donor evaluation leads to a higher exclusion rate. J Urol. 2007;177(5):1826–9.CrossRefGoogle Scholar
  13. 13.
    Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberu 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.PubMedGoogle Scholar
  14. 14.
    Mandelbrot DA, Pavlakis M, Danovitch GM, Johnson SR, Karp SJ, Khwaja K, et al. The medical evaluation of living kidney donors: a survey of US transplant centers. Am J Transplant. 2007;7(10):2333–43.CrossRefGoogle Scholar
  15. 15.
    Ennis J, Kocherginsky M, Schumm LP, Worcester E, Coe FL, Josephson MA. Trends in kidney donation among kidney stone formers: a survey of US transplant centers. Am J Nephrol. 2009;30(1):12–8.CrossRefGoogle Scholar
  16. 16.
    Goldfarb DS. The search for monogenic causes of kidney stones. J Am Soc Nephrol. 2015;26(3):507–10.CrossRefGoogle Scholar
  17. 17.
    Goldfarb DS, Fischer ME, Keich Y, Goldberg J. A twin study of genetic and dietary influences on nephrolithiasis: a report from the Vietnam Era Twin (VET) Registry. Kidney Int. 2005;67(3):1053–61.CrossRefGoogle Scholar
  18. 18.
    Sayer JA. Progress in understanding the genetics of calcium-containing nephrolithiasis. J Am Soc Nephrol. 2017;28(3):748–59.CrossRefGoogle Scholar
  19. 19.
    Lee YH, Huang WC, Chang LS, Chen MT, Yang YF, Huang JK. The long-term stone recurrence rate and renal function change in unilateral nephrectomy urolithiasis patients. J Urol. 1994;152(5 Pt 1):1386–8.CrossRefGoogle Scholar
  20. 20.
    Trinchieri A, Ostini F, Nespoli R, Rovera F, Montanari E, Zanetti G. A prospective study of recurrence rate and risk factors for recurrence after a first renal stone. J Urol. 1999;162(1):27–30.CrossRefGoogle Scholar
  21. 21.
    Olsburgh J, Thomas K, Wong K, Bultitude M, Glass J, Rottenberg G, et al. Incidental renal stones in potential live kidney donors: prevalence, assessment and donation, including role of ex vivo ureteroscopy. BJU Int. 2013;111(5):784–92.CrossRefGoogle Scholar
  22. 22.
    Recurrence of Kidney Stone (ROKS): Risk calculator. (2014). Accessed 10 Jun 2018.
  23. 23.
    SRTR: Program-specific reports. (2018). Accessed 10 Jun 2018.

Copyright information

© Japanese Society of Nephrology 2019

Authors and Affiliations

  • V. S. Tatapudi
    • 1
    Email author
  • F. Modersitzki
    • 2
  • S. Marineci
    • 3
  • M. A. Josephson
    • 4
  • D. S. Goldfarb
    • 2
    • 3
  1. 1.NYU Langone Transplant Institute, NYU Langone HealthNew York University School of MedicineNew YorkUSA
  2. 2.Nephrology SectionNew York Harbor VA Medical Center and NYU School of MedicineNew YorkUSA
  3. 3.Division of Nephrology, Department of Internal MedicineNYU Langone HealthNew YorkUSA
  4. 4.Section of Nephrology, Department of MedicineUniversity of Chicago MedicineChicagoUSA

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