Dr Tess Cooper1, Prof Kate Wyburn1,3, Dr Laura Smith1, Dr Melanie Wyld1,2
1Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia, 2Department of Renal Medicine, Westmead Hospital, Westmead, Australia, 3Department of Renal Medicine, Royal Prince Alfred Hospital, Camperdown, Australia
Biography:
Melanie Wyld (B.Econ(Hons) MBBS MBA MPH PhD FRACP) is a nephrologist at Westmead Hospital and senior lecturer in clinical epidemiology at the School of Public Health, Faculty of Medicine and Health, University of Sydney. She received her PhD ‘Health outcomes and cost-effectiveness in kidney disease’ in 2019 from the University of Sydney. She is a clinical researcher with research interests in living donor kidney transplantation and equity of access to care. She is the Chair of Equity Diversity and Inclusion Committee of ANZSN, Chair of TSANZ’s Living Donor Transplantation Working Group, and Chair of ANZDATA’s Living Donor Working Group.
Aims:
To characterise the cardiovascular and metabolic criteria used by Australian nephrologists when assessing potential living kidney donors and to explore variation in current practices.
Background:
The evaluation of potential living kidney donors is complex, and practices vary substantially across clinicians and institutions. Despite the critical nature of cardiovascular and metabolic screening for donor safety, little is known about the variability in Australia.
Methods:
An online survey comprising 24 questions was distributed between February and April 2024 to Australian nephrologists involved in donor assessments. The survey collected data on respondent demographics, assessment methods, and exclusion thresholds. Responses were analysed descriptively.
Results:
Thirty-six nephrologists participated (56% transplant; 44% general). Assessment practices varied: 72% used stress testing in donors with cardiovascular risk factors, 58% used echocardiography, 56% performed 24-hour ambulatory blood pressure monitoring, and 67% routinely conducted oral glucose tolerance testing. Frequent exclusion criteria included hypertension treated with ≥2 antihypertensives(47%), mild diastolic dysfunction in well-controlled hypertension(50%), mild diastolic dysfunction without hypertension or obesity(39%), second degree heart block(47%), right bundle branch block(50%), atrial fibrillation(64%); mild left ventricular hypertrophy(53%), pre-diabetics with a 2-hour OGTT ≥7.8mg/mmol(64%); obesity (body mass index >30 kg/m2(69%)), strong family history of diabetes combined with pre-diabetes or obesity (53%), tobacco (64%) or marijuana (44%) smoking, history of substance use disorder (39%) or if insufficient abstinence period (35%); alcohol use disorder if insufficient abstinence period (35%); and female donors who had not completed their families (56%).
Conclusion:
These findings underscore profound variations in living donor evaluation across Australia, reflecting a lack of consensus-driven, evidence-based guidelines. Establishing national standards would harmonise assessment practices, enhance donor safety, and strengthen the integrity of living kidney transplantation programs.
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