Living Renal Donor Allograft Lithiasis: A Review of Stone Related Morbidity in Donors and Recipients
Purpose
The use of screening computerized tomography angiography has resulted in the increased detection of incidental nephrolithiasis in potential living renal donor candidates. We reviewed current acceptance guidelines for donors with stone disease as well as data on stone related outcomes in donors with stone disease and recipients who received a kidney with a stone left in situ.
Materials and Methods
We performed a medical literature search in English using MEDLINE®/PubMed® that addressed renal donor allograft lithiasis. We then analyzed the literature with respect to the historical evolution of this concept, current guidelines regarding the acceptance of donors with stones and stone related morbidity in recipients and donors.
Results
The prevalence of asymptomatic solitary nephrolithiasis has increased with the widespread use of screening computerized tomography angiography during renal donor evaluation. Few studies have addressed the risk of stone related morbidity in donors and recipients. Short-term studies have shown little stone related morbidity in patients who donate or receive an allograft with a stone left in situ. Consensus statements from transplant societies around the world offer guidance for determining donor eligibility.
Conclusions
The available literature on stone related morbidity in donors and recipients is extremely limited. It would appear that the risk of recurrence and subsequent morbidity in renal donors with a solitary kidney is low but not insignificant. Rare stone related adverse events are reported for recipients of an allograft with a stone left in situ. Renal donors and recipients should be educated regarding their unique risk perspectives. Long-term followup is mandatory.
Key Words: kidney, kidney transplantation, living donors, kidney calculi, angiography, digital subtraction
Abbreviations and Acronyms: CT, computerized tomography
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Editor’s Note: This article is the second of 5 published in this issue for which category 1 CME credits can be earned. Instructions for obtaining credits are given with the questions on pages 1208 and 1209.
For other articles on a related topic see pages 1184 and 1190.
PII: S0022-5347(07)02752-8
doi:10.1016/j.juro.2007.10.022
© 2008 American Urological Association. Published by Elsevier Inc. All rights reserved.
Refers to article:
- Evaluation of the Ischemic Protection Efficacy of a Laparoscopic Renal Cooling Device Using Renal Transplantation Viability Assessment Criteria in a Porcine Model , 17 January 2008
- Treatment of Hyperhomocysteinemia and Endothelial Dysfunction in Renal Transplant Recipients With B Vitamins in the Chinese Population , 17 January 2008