Estimated Glomerular Filtration Rate Less Than 90 mL/min/1.73m2 in Living Donor Candidates Under 30 Years Old and Long‐Term Outcomes
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Wiley
2025
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| author | Erika S. Helgeson David M. Vock Raja Kandaswamy Arthur J. Matas |
| author_facet | Erika S. Helgeson David M. Vock Raja Kandaswamy Arthur J. Matas Erika S. Helgeson David M. Vock Raja Kandaswamy Arthur J. Matas |
| collection | Wiley Open Access |
| contents | Estimated Glomerular Filtration Rate Less Than 90 mL/min/1.73m2 in Living Donor Candidates Under 30 Years Old and Long‐Term Outcomes Erika S. Helgeson David M. Vock Raja Kandaswamy Arthur J. Matas Clinical Transplantation ABSTRACTBackgroundTraditionally, glomerular filtration rate (GFR) ≥80 mL/min/1.73 m2 has been the threshold for living kidney donor (LKDs) acceptance. Recently, the threshold has been lowered for older donors. There is consideration of raising it for younger donors.MethodsWe compared long‐term outcomes for LKDs age 18–29 with predonation eGFR < 90 to those with eGFR ≥ 90. LKDs with eGFR <90 were matched 1:3 to LKDs with eGFR ≥ 90 using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for age; systolic blood pressure; glucose; BMI; sex; donation year; relationship to recipient, smoking status; and family history of diabetes, hypertension, and cardiovascular disease (CVD). Incidence of death, eGFR < 45, hypertension, diabetes, and CVD were compared between groups using Cox proportional hazards (for death) and Fine‐Gray regression models treating death as a competing risk.ResultsOf 965 LKDs age 18–29 with follow‐up information, median [quartiles] age at donation was 25.4 [22.5, 27.6]; 54.0% were female, 91.6% White, 87% non‐Hispanic; 158 (16.4%) had predonation eGFR < 90. LKDs with eGFR < 90 tended to donate during an earlier era (median year: 1982 vs. 1990, p < 0.001) to a first degree relative (86.7% vs. 75.3%, p = 0.008) and have a family history of diabetes (53.8% vs. 40.6%, p = 0.009). During a median follow‐up of 25 [12, 37] years no associations were detected between low predonation eGFR and death, eGFR < 45, hypertension, diabetes, or CVD. Results among LKDs age < 25 were similar.ConclusionsOur data do not support increasing the eGFR threshold among young White non‐Hispanic donor candidates, reducing one barrier to living donation. 10.1111/ctr.70240 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| doi_str_mv | 10.1111/ctr.70240 |
| format | Artículo Open Access |
| id | wiley_oa_10_1111_ctr_70240 |
| institution | Wiley Open Access |
| license_str_mv | http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| publishDate | 2025 |
| publisher | Wiley |
| record_format | wiley_oa |
| spellingShingle | Estimated Glomerular Filtration Rate Less Than 90 mL/min/1.73m2 in Living Donor Candidates Under 30 Years Old and Long‐Term Outcomes Erika S. Helgeson David M. Vock Raja Kandaswamy Arthur J. Matas Clinical Transplantation Estimated Glomerular Filtration Rate Less Than 90 mL/min/1.73m2 in Living Donor Candidates Under 30 Years Old and Long‐Term Outcomes Erika S. Helgeson David M. Vock Raja Kandaswamy Arthur J. Matas Clinical Transplantation ABSTRACTBackgroundTraditionally, glomerular filtration rate (GFR) ≥80 mL/min/1.73 m2 has been the threshold for living kidney donor (LKDs) acceptance. Recently, the threshold has been lowered for older donors. There is consideration of raising it for younger donors.MethodsWe compared long‐term outcomes for LKDs age 18–29 with predonation eGFR < 90 to those with eGFR ≥ 90. LKDs with eGFR <90 were matched 1:3 to LKDs with eGFR ≥ 90 using nearest neighbor propensity score matching. Propensity scores were estimated using logistic regression with covariates for age; systolic blood pressure; glucose; BMI; sex; donation year; relationship to recipient, smoking status; and family history of diabetes, hypertension, and cardiovascular disease (CVD). Incidence of death, eGFR < 45, hypertension, diabetes, and CVD were compared between groups using Cox proportional hazards (for death) and Fine‐Gray regression models treating death as a competing risk.ResultsOf 965 LKDs age 18–29 with follow‐up information, median [quartiles] age at donation was 25.4 [22.5, 27.6]; 54.0% were female, 91.6% White, 87% non‐Hispanic; 158 (16.4%) had predonation eGFR < 90. LKDs with eGFR < 90 tended to donate during an earlier era (median year: 1982 vs. 1990, p < 0.001) to a first degree relative (86.7% vs. 75.3%, p = 0.008) and have a family history of diabetes (53.8% vs. 40.6%, p = 0.009). During a median follow‐up of 25 [12, 37] years no associations were detected between low predonation eGFR and death, eGFR < 45, hypertension, diabetes, or CVD. Results among LKDs age < 25 were similar.ConclusionsOur data do not support increasing the eGFR threshold among young White non‐Hispanic donor candidates, reducing one barrier to living donation. 10.1111/ctr.70240 http://creativecommons.org/licenses/by-nc-nd/4.0/ |
| title | Estimated Glomerular Filtration Rate Less Than 90 mL/min/1.73m2 in Living Donor Candidates Under 30 Years Old and Long‐Term Outcomes |
| topic | Clinical Transplantation |
| url | https://onlinelibrary.wiley.com/doi/10.1111/ctr.70240 |