The donors with metabolic syndrome had lower pre- and postdonation GFR [kidney function] but similar fractional decline in GFR than donors without metabolic syndrome. In line with results from the Netherlands study, the donors with metabolic syndrome were unable to compensate promptly and completely, which could be explained by their unfavorable renal histology. At follow-up, the donors were encouraged to adopt healthy lifestyle which resulted in weight loss and improved metabolic profile in over half the donors. This may eventually translate into better renal/cardiovascular outcomes [kidney/heart]. The study aligns with numerous others that have called for donor follow-up and counseling, as most donors do not seek medical attention.
Looking at the donor characteristics, study size, duration and BMI-based definition of metabolic syndrome, we must be cautious in accepting kidneys from such donors and extrapolating the results to extremely obese, hypertensive and non-white donors. Also, the encouraging findings of reversibility of metabolic syndrome are dependent on establishment of donor wellness and follow-up clinic, and donor participation, and donor willingness to adopt a healthy lifestyle.
Unfortunately, this study is based on a small number or living kidney donors. Also, the emphasis on follow-up and wellness clinics is important because the researchers know that such things don’t exists in the U.S. Transplant center are not required to, nor do they, ensure their living donors are maintaining healthy lifestyles post-donation.
Doshi MD (2013). Not Seeing Does Not Equal Absent-Acceptance of Live Kidney Donors With Metabolic Syndrome. American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons PMID: 23914825