Nefrología

ISSN: 0211-6995
e-ISSN: 1989-2284

Nefrología es la publicación oficial de la Sociedad Española de Nefrología. La revista publica artículos sobre investigación básica o clínica relacionada con la nefrología, la hipertensión arterial, la diálisis y el trasplante de riñón. La revista sigue la normativa del sistema de revisión por pares, de modo que todos los artículos originales son evaluados tanto por el comité como por revisores externos. La revista acepta artículos escritos en español o en inglés. Nefrología sigue las normas de publicación del Comité Internacional de Editores de Revistas Médicas (ICMJE) y del Comité sobre Publicación Ética (COPE).

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Abstract
Keywords
Abbreviations and acronyms
Resumen
Introduction, objectives and methodology
The current situation of living donor renal transplantation in spain and other countries
The need for living donor kt
Living donor kt results
Changes in deceased donor profile and the waiting list
Improving living donor safety
Donor protection
The evolution of living donor kt in spain and how it compares with other countries
Adapting the living donor kt scheme to new needs
Optimising the living donor kt scheme
Regulations governing living donor kt in spain
Law 30/79, of 27 october, on the harvesting and transplantation of organs, and royal decree 1723/2012, of 28 december.
Royal decree 1723/2012, of 28 december, which governs the activities of obtaining and clinically using human organs, and the territorial coordination of the human organs destined for transplantation, establishing quality and safety requisites.
Authorized hospitals. competences of the autonomous regions.
Informed consent. exceptional donors: “competent” minors and “incompetent” adults.
Penalties for buying and selling organs. detecting and reporting cases of illegality committed outside spain.
Documentation and custody of the same
Paired transplantation and altruistic donation. confidentiality in indirect donations.
Appearance in court
Ethical aspects of living donor donation and kt
Analysis of donor autonomy
Decisions in donor selection based on sex
Analysis of altruism
Accreditation of donor identity and their relationship with the recipient
Anonymity
Procedure in the case of unforeseen results
Risks analysis and information for the donor
Evaluation of non-resident living donors
Signing the informed consent (ic) document
The healthcare ethics committee (hec) in living donation
Information in living renal donation
Information about types of renal replacement therapy
The basic information required for potential renal donors to give their consent
Preliminary approach to the viability of donation
Social information and the media
Time off work, economic costs, life insurance policies and applying for loans
Assessment, clinical history and specific tests for living renal donors
General analysis and radiology
Evaluation of donor renal function
Detection of tumours in the donor
Hereditary renal diseases or those with a familial component
The risk of transmitting infectious diseases
Haematological diseases of the donor
Psychological evaluation of living renal donors
Living donor psychological assessment protocol
Living donor selection and acceptance criteria
The psychological interview
Psychometric assessment
Donor follow-up
Living renal donors with borderline alterations: acceptance and rejection criteria.
Limits to donation based on donor gfr
Donor age as a limit to donation
Minor urinary alterations and their impact on donation
Dyslipidaemia
Hyperuricaemia and gout
Smoking
Alcohol consumption and addiction to other drugs
Metabolic evaluation and healthy lifestyles before and after living renal donation
Obesity
Arterial hypertension
Diabetes mellitus and metabolic syndrome
Compatibility and incompatibility in living donor kt
Compatibility barriers
Planned study of the donor-recipient pair
Practical procedure for the study of a ldkt candidate pair
Recommendations for the management of hla incompatibility (figure 11)
Living donor nephrectomy
Donor selection and planning surgery
Surgical technique
Recipient surgery in living donor kt
Conventional open surgery
Robotic kt
Immunosuppression in ldkt
Immunosuppression induction therapy in ldkt
Maintenance immunosuppressant treatment in ldkt recipients
Alternative drugs for maintenance immunosuppression
Living donor paediatric recipients
Demographic aspects of paediatric kt
Advantages of living donation for paediatric recipients
Paediatric recipients of ldkt
Very young recipients of living donor transplantation
Adolescent ldkt recipients
Kt from an adult donor to a very young recipient (donor-recipient disassociation)
What is the age limit for a living donor to a paediatric recipient?
Complex vascular anomalies in ldkt and paediatric recipients
Complex urological anomalies and treating them in ldkt and paediatric recipient
Cancer in the paediatric recipient
Intellectual retardation and the paediatric recipient
Obesity and the paediatric recipient
Abo incompatible living donor kt and paediatric recipients
Living donor kt in highly sensitized paediatric recipients
Absolute contraindications in paediatric recipients
Considerations on choice of a live donor for children
Ldkt with hla incompatibility
Desensitization for hla-incompatible ldkt
Results
Probability of transplantation
Survival and rejection
Complications and cost of desensitization
Living donor with abo incompatibility
The effectiveness of abo-incompatible ldkt
What do we need to study to carry out an abo-incompatible ldkt?
How should isoagglutinins be measured?
Desensitization techniques (table 14)
Paired kidney transplantation and altruistic donors
Foundations of the paired kt scheme in spain
Exchange options within the scheme (figure 14):
Participating hospitals
Computer tool
Action protocol
Results of paired transplantation rounds
Transplantation logistics
Altruistic donors
National and international data
Action protocol
Evaluation of altruistic donors
Specific considerations to be taken into account during assessment
Information
Expectations
Motivation
Age
Family and social support
Registration
Renal assignation of an altruistic donor
Analysis of the risks for living renal donors over the medium and long-terms
Cardiovascular risks for renal donors
The impact of the fall in the gfr after donation on long-term mortality
The risk of preeclampsia in donors
Kt in renal donors
Mortality due to any cause
Results of ldkt in standard and special situations
Transplantation versus dialysis
Expanded living donor kt criteria
High risk recipients
Coordination of the living kidney donation process
Coordination of living donor kt
Initial assessment by the nephrologist who is responsible for the living donor
Offer the donor a free space where they can express their doubts and resolve questions
Review of the documentation and the relationship of the living donor with the potential recipient (table 1)
Coordination of the general study of a living donor and the necessary tests in each specific case
Collaboration in decision-making and the socioeconomic, familial, social and professional evaluation of a donor
Participation in the informed consent procedure
Arranging the multidisciplinary meeting to accept a living donor
Coordination of the legal process: theec and appearing before the court
Ldkt report for the competent authorities and the registry.
Renal transport management in the paired living donor scheme
Conflict of interests
Acknowledgements
Bibliografía

Original article

DOI: 10.1016/j.nefroe.2022.07.001

Open Access

Recommendations for living donor kidney transplantation

Recomendaciones para el trasplante renal de donante vivo

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Miguel Ángel Frutosa,1,

Autor para correspondencia

miguel.frutos@gmail.com

Corresponding authors.

, Marta Crespob,1, María de la Oliva Valentínc,1, Ángel Alonso-Melgard, Juana Alonsoa, Constantino Fernándeze, Gorka García-Erauzkinf, Esther Gonzálezg, Ana M. González–Rinneh, Lluis Guiradoi, Alex Gutiérrez-Dalmauj, Jorge Huguetk, José Luis López del Morall, Mireia Musqueram, David Paredesn, Dolores Redondob, Ignacio Revueltao, Carlos J Van-der Hofstadtp, Antonio Alcarazm, Ángel Alonso-Hernándeze..., Manuel Alonsoq, Purificación Bernabeup, Gabriel Bernalr, Alberto Bredak, Mercedes Cabelloa, José Luis Caro-Oleass, Joan Cidt, Fritz Diekmanno, Laura Espinosad, Carme Facundoi, Marta Garcíac, Salvador Gil-Vernetu, Miquel Lozanot, Beatriz Mahilloc, María José Martínezv, Blanca Mirandaw, Federico Oppenheimero, Eduard Palous, María José Pérez-Saezb, Lluis Perim, Oscar Rodríguezk, Carlos Santiagox, Guadalupe Taberneroy, Domingo Hernándeza, Beatriz Domínguez-Gilc, Julio Pascualb,

Autor para correspondencia

julpascual@gmail.com

Corresponding authors.

a Nephrology Department, Hospital Regional Universitario de Málaga, Spain

b Nephrology Department, Hospital del Mar, Barcelona, Spain

c National Transplant Organization, Madrid, Spain

d Paediatric Nephrology Department, Hospital La Paz, Madrid, Spain

e Nephrology Department, Hospital Universitario A Coruña, Spain

f Nephrology Department, Hospital Universitario de Cruces, Bilbao, Spain

g Nephrology Department, Hospital Universitario 12 Octubre, Spain

h Nephrology Department, Hospital Universitario de Canarias, Spain

i Nephrology Department, Fundacio Puigvert, Barcelona, Spain

j Nephrology Department, Hospital Universitario Miguel Servet, Zaragoza, Spain

k RT Surgical Team, Fundació Puigvert, Barcelona, Spain

l Cantabria High Court Magistrate, Spain

m Urology Department, Hospital Clinic Universitari, Barcelona, Spain

n Donation and Transplantation Coordination Department, Hospital Clinic Universitari, Barcelona, Spain

o Nephrology and RT Department, Hospital Clinic Universitari, Barcelona, Spain

p Hospital Psychology Unit, Hospital General Universitario de Alicante, Spain

q Regional Transplantation Coordination, Seville, Spain

r Nephrology Department, Hospital Universitario Virgen del Rocío, Seville, Spain

s Immunology Department, Hospital Clinic i Universitari, Barcelona, Spain

t Apheresis and Cell Therapy Unit, Haemotherapy and Haemostasis Department, Hospital Clinic Universitari, Barcelona, Spain

u Nephrology Department, Hospital Universitari de Bellvitge, Barcelona, Spain

v Paediatric Urology Department, Hospital Universitario La Paz, Madrid, Spain

w Fundación Renal Iñigo Álvarez de Toledo, Madrid, Spain

x Nephrology Department, Hospital General de Alicante, Spain

y Nephrology Department, Hospital Universitario de Salamanca, Spain

Artículo

This article is available in English

Recommendations for living donor kidney transplantation

Miguel Ángel Frutos, Marta Crespo, María de la Oliva Valentín, Ángel Alonso-Melgar, Juana Alonso, Constantino Fernández, Gorka García-Erauzkin, Esther González, Ana M. González–Rinne, Lluis Guirado, Alex Gutiérrez-Dalmau, Jorge Huguet, José Luis López del Moral, Mireia Musquera, David Paredes, Dolores Redondo, Ignacio Revuelta, Carlos J Van-der Hofstadt, Antonio Alcaraz, Ángel Alonso-Hernández, Manuel Alonso, Purificación Bernabeu, Gabriel Bernal, Alberto Breda, Mercedes Cabello, José Luis Caro-Oleas, Joan Cid, Fritz Diekmann, Laura Espinosa, Carme Facundo, Marta García, Salvador Gil-Vernet, Miquel Lozano, Beatriz Mahillo, María José Martínez, Blanca Miranda, Federico Oppenheimer, Eduard Palou, María José Pérez-Saez, Lluis Peri, Oscar Rodríguez, Carlos Santiago, Guadalupe Tabernero, Domingo Hernández, Beatriz Domínguez-Gil, Julio Pascual

10.1016/j.nefroe.2022.07.001

Nefrologia (English Version). 2022;42 Supl 2:5-132

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Artículo

Recommendations for living donor kidney transplantation

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