The US transplant industry have been expanding the criteria for what they deem are ‘acceptable’ living donors. This means that living donors have gotten older, fatter (higher BMI) and with more pre-existing health issues (Poggio 2009).
One center decided to look at how their living kidney donors with metabolic syndrome fared post-donation.
According to the National Institute of Health, Metabolic Syndrome is defined as having three out of five risk factors that raise one’s risk of heart disease and other health problems, such as diabetes and stroke.
The factors include:
– large waist line or ‘apple’ shape.
– high triglyceride level
– low HDL cholesterol (aka ‘good’ cholesterol)
– high blood pressure
– high fasting blood sugar.
[Note: Unfortunately, I only have access to the abstract so I don’t know long any of the LKDs were actually followed]
As always, the bold is mine.
We studied the association of metabolic syndrome with kidney function and histology in 410 donors from 2005 to 2012, of whom 178 donors were systematically followed after donation since 2009. Metabolic syndrome was defined as per the NCEP ATPIII criteria, but using a BMI>25 kg/m2 instead of waist circumference.
Following donation, donors received counseling on lifestyle modification.
Metabolic syndrome was present in 50 (12.2%) donors. Donors with metabolic syndrome were more likely to have chronic histological changes on implant biopsies than donors with no metabolic syndrome (29.0% vs. 9.3%, p<0.001). This finding was associated with impaired kidney function recovery following donation. At last follow-up, reversal of metabolic syndrome was observed in 57.1% of donors with predonation metabolic syndrome, while only 10.8% of donors developed de novo metabolic syndrome (p<?0.001).
In conclusion, metabolic syndrome in donors is associated with chronic histological changes, and nephrectomy in these donors was associated with subsequent protracted recovery of kidney function. Importantly, weight loss led to improvement of most abnormalities that define metabolic syndrome.
I’m curious to know what the authors mean by ‘counseling’. A pile of papers? Extended, multiple appointments? Inclusion in a support group? Folks who undergo weight loss surgery are enrolled in support groups and counseling from the moment they embark on the pre-surgical process until a year or more after the procedure. Was this paradigm applied to living kidney donors diagnosed with metabolic syndrome?
Considering that the results confirm weight loss’ positive impact on metabolic syndrome, this study could be the first step in acknowledging the importance of ongoing support and education for living donors in maintaining their health post-donation.
Ohashi Y, Thomas G, Nurko S, Stephany B, Fatica R, Chiesa A, Rule AD, Srinivas T, Schold JD, Navaneethan SD, & Poggio ED (2013). Association of Metabolic Syndrome With Kidney Function and Histology in Living Kidney Donors. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons PMID: 23865821