Title
Living Kidney Donors
Authoring Organization
Publication Month/Year
August 1, 2017
Last Updated Month/Year
June 9, 2022
Supplemental Implementation Tools
Document Type
Guideline
External Publication Status
Published
Country of Publication
US
Inclusion Criteria
Female, Male, Adolescent, Adult, Child, Infant, Older adult
Health Care Settings
Hospital, Operating and recovery room, Outpatient
Intended Users
Genetics, epidemiology infection prevention, counselor, nurse, nurse practitioner, physician, physician assistant
Scope
Management, Treatment
Diseases/Conditions (MeSH)
D003587 - Cytomegalovirus, D014019 - Tissue Donors, D020031 - Epstein-Barr Virus Infections
Keywords
cytomegalovirus, Living Kidney Donors, Epstein Barr Virus
Supplemental Methodology Resources
Methodology
Number of Source Documents
58
Literature Search Start Date
January 1, 1974
Literature Search End Date
September 30, 2014
Description of External Review Process
The guideline had undergone external public review in October 2013.
External Review Process Start Date
October 1, 2013
External Review Process End Date
October 31, 2013
Description of Public Comment Process
Public review comments were compiled and fed back to the Work Group, which considered comments in its revision of the guideline.
Specialties Involved
Family Medicine, Internal Medicine General, Nephrology
Description of Systematic Review
The cochairs met with the evidence review team (ERT) to outline key questions amenable to formal evidence review and the literature search strategy. The search was conducted by the ERT and 2 face-to-face guideline work group meetings were subsequently held with the ERT. Given the paucity of published evidence to support living donor evaluation, the work group decided at their second meeting to ask the Chronic Kidney Disease Prognosis Consortium1 to estimate the longterm risk of end-stage renal disease (kidney failure requiring dialysis or transplantation), according to a donor candidate’s profile of demographic and health characteristics. Results from this published work, along with the development of an online tool (http://www.transplantmodels.com/esrdrisk/)2 to estimate the risk of kidney failure in the absence of donation (predonation risk), provide a quantitative framework for evaluating donor candidates
List of Questions
The Population, Intervention, Comparator, Outcome, study Design, and Duration of follow-up (PICODDs) criteria for the systematic review (Table 2) are described in detail in an accompanying publication.3 Outcomes were selected and ranked by assessing patient-centeredness. Risk assessment periods were defined as perinephrectomy/ postnephrectomy (within 90 days of donation), and longerterm (after 90 days postdonation until the end of available follow-up). Long-term outcomes were based on a mean follow-up of at least 5 years.
Description of Study Criteria
The ERT extracted data from systematic reviews and observational studies with sample sizes over 100 and mean follow-up of at least 5 years. Explicit recognition of perspectives of comparison is critical for drawing inferences about donor health outcomes (eg, estimation of predonation risk, absolute postdonation risk and donation-attributable risk) (Figure 1),4 and types of comparison were a critical consideration throughout the development of this guideline, including the design and conduct of the evidence review. To be included, studies needed an adequate comparison group that excluded subjects with contraindications to kidney donation. The ERT examined both short- and long-term donor outcomes.
Description of Search Strategy
The ERT searched Ovid Medline, Ovid Embase, and the Cochrane Library to identify relevant systematic reviews, randomized-controlled trials, and observational studies published through September 2014.
Description of Study Selection
The search was conducted by the ERT and 2 face-to-face guideline work group meetings were subsequently held with the ERT. Given the paucity of published evidence to support living donor evaluation, the work group decided at their second meeting to ask the Chronic Kidney Disease Prognosis Consortium1 to estimate the longterm risk of end-stage renal disease (kidney failure requiring dialysis or transplantation), according to a donor candidate’s profile of demographic and health characteristics. Results from this published work, along with the development of an online tool (http://www.transplantmodels.com/esrdrisk/)2 to estimate the risk of kidney failure in the absence of donation (predonation risk), provide a quantitative framework for evaluating donor candidates.
Description of Evidence Analysis Methods
For perinephrectomy/postnephrectomy outcomes defined in the search criteria, the ERT extracted data from relevant comparisons in recent systematic reviews rather than performing a de novo extraction process. The ERT extracted relevant narrative information from systematic reviews that did not provide meta-analyses. For long-term outcomes defined in the search criteria, the ERT extracted data from observational studies and extracted pooled results from previous meta-analyses. One investigator extracted relevant study, population demographic, and outcomes data from studies eligible for full extraction. Data fields extracted included author, year of publication, setting, donor and comparison populations, inclusion and exclusion criteria, donor and comparison characteristics, follow-up duration, descriptions, and results of outcomes. Relevant data were extracted into tables for descriptive analysis. In several cases, many comparisons were made within the same published study. In these cases, the ERT extracted relevant comparisons but did not extract ineligible comparisons
Description of Evidence Grading
KDIGO adopted GRADE.
A: High. The Work Group is confident that the true effect lies close to that of the estimate of the effect.
B: Moderate. The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different.
C: Low. The true effect may be substantially different from the estimate of the effect.
D: Very low. The estimate of effect is very uncertain and often will be far from the truth
Description of Recommendation Grading
KDIGO uses a GRADE Methodology. Most recommendations were “ungraded” expert consensus recommendations.
Level 1. Strong Recommendation: “We Recommend.” Clinicians: most patients should receive the recommended course of action.
Level 2 Conditional Recommendation: “We Suggest.” Clinicians: Different choices will be appropriate for different patients. Each patient needs help to arrive at a management decision consistent with her or his values and preferences.
Description of Funding Source
This guideline is funded by KDIGO with contributions from Canadian Blood Services, Canadian Society of Nephrology, Minneapolis Medical Research Foundation, and The Transplantation Society. Financial disclosures of Work Group members are published in Biographic and Disclosure Information section of the guideline.
Company/Author Disclosures
Financial disclosures of Work Group members are published in Biographic and Disclosure Information section of the guideline.
Percentage of Authors Reporting COI
100