title: The Medically Complex Living Kidney Donor: Glucose Metabolism as Principal Cause of Donor Declination.
abstract: BACKGROUND
  Transplant centers are increasingly confronted with medically complex living kidney donor candidates. Considerable differences exist among centers regarding handling of these patients and little data is available on characteristics, evaluation outcome and declination criteria. We now demonstrate impaired glucose metabolism to be the largest single cause of donor declination.
  
  
  METHODS
  Follow-up of 133 donor-recipient pairs, presenting to our transplant center between 03/2007 and 06/2012 was included in the analysis. Evaluation outcome of donor-recipient pairs was assessed and declinations stratified into donor or recipient reasons and underlying conditions.
  
  
  RESULTS
  65 donor-recipient pairs (49%) were accepted for transplantation, 68 (51%) were declined upon first evaluation. 77% of declinations were for donor- and 23% for recipient reasons. Almost half of donor declinations resulted from increased cardiovascular risk with the presence of diabetes mellitus or prediabetes as the largest single cause of declination.
  
  
  CONCLUSIONS
  Glucose metabolism is key in donor risk assessment and precludes kidney donation if abnormal. The high prevalence emphasizes the need for prevention. Prediabetes defines a cohort at risk and response to lifestyle intervention allows for individual risk stratification, thereby potentially increasing the number of persons eligible for kidney donation. Unification of evaluation criteria, as well as prospective long-term follow-up is required to account for increasingly complex living kidney donors.
authors.affiliation: Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany.
authors.forename: Martina
authors.initials: M
authors.lastname: Guthoff
authors.affiliation: Department of General-, Visceral- and Transplant Surgery, University of Tübingen, Tübingen, Germany.
authors.forename: Silvio
authors.initials: S
authors.lastname: Nadalin
authors.affiliation: Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Fritsche
authors.affiliation: Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany.
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
authors.affiliation: Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany.
authors.forename: Hans-Ulrich
authors.initials: HU
authors.lastname: Häring
authors.affiliation: Department of Endocrinology and Diabetology, Angiology, Nephrology and Clinical Chemistry, University of Tübingen, Tübingen, Germany.
authors.forename: Nils
authors.initials: N
authors.lastname: Heyne
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D000066491:Clinical Decision-Making / Q000379:methods*; D046148:Donor Selection / Q000379:methods* / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D005858:Germany; D044882:Glucose Metabolism Disorders; D006801:Humans; D016030:Kidney Transplantation / Q000706:statistics & numerical data*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult