GFR Assessment of Living Kidney Donors Candidates

Living kidney donation provides the best outcomes (survival, cost and quality of life) of all renal replacement modalities. Living kidney donors on the other hand are at increased risk of end stage kidney disease (ESKD) after donation as compared to healthy non-donors for multiple possible reasons. Extensive pre-donation screening is required to assess eligibility for donation to avoid the rejection of suitable candidates and minimize acceptance of donors with increased risk of ESKD. The association between lower pre-donation glomerular filtration rate (GFR) and increased ESKD risk in donors highlights the relevance of GFR assessment for living kidney donor candidates. However, the method to evaluate GFR is still debated and the thresholds of acceptable pre-donation GFR vary across guidelines. All guidelines favour GFR measurement (mGFR) with an exogenous tracer over estimated GFR (eGFR) but only the British Transplant Society (BTS) guidelines mandates it. While the KDIGO guidelines advocates for age-independent GFR thresholds, most other guidelines propose various age-dependent GFR thresholds with resulting profound differences in assessment of donor suitability between guidelines. Many important questions are not addressed by any guidelines including the approach to discordant mGFR and eGFR results, the use of method-specific GFR thresholds and thresholds dependent on co-morbidities or race. Further data is required exploring the associations between theses variables and the course of post-donation GFR. Last, GFR evaluation studies conducted in approved donors and not in those initially presenting as potential candidates, are questionable regarding their suitability for potential donor evaluation. Disclosures: The authors declare no conflicts of interest Funding: None Corresponding author: François Gaillard, gaillard.f@protonmail.com, Nephrology and transplantation department, Hôpital Necker-Enfants malades, 149 rue de Sèvres 75015 Paris France. Tel: +33 (0)1 44 49 54 49; Fax: +33 (0)1 44 49 25 09 Copyright © 2019 Wolters Kluwer Health, Inc. All rights reserved.

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