Living Kidney Donor Dropout At The Kenyatta National Hospital Transplant Program.

Abstract

BACKGROUND. Kidney transplantation involves transplanting a healthy kidney to a patient with ESRD. Donors can either be living or deceased. Living donation offers the advantage of optimal preparation of both the recipient and the donor and allows better logistical control. Not every potential donor that starts the evaluation process eventually donates a kidney. The reasons for this are varied and range from medical contraindications to social or ethical dilemmas. METHODS. We conducted a retrospective descriptive study at the Kenyatta National Hospital transplant clinic. Medical records of all living kidney donors who enrolled into the transplant program during the period from January 2010 to September 2018 were obtained. All donors that did not successfully donate to their intended recipient were segregated and data pertaining to their sociodemographic characteristics and reason(s) for exclusion were obtained and data analysed using statistical package for social scientists (SPSS) version 22.0 for windows. RESULTS. The study was conducted between October and December 2018. During this period medical files of 286 donors that were evaluated during the period between, January 2010 and September 2018, were obtained. A total of 121 medical records of donors who were excluded were analysed. There was a male preponderance with a male to female ratio of 1.8 :1. The mean age was 33.4 years, majority (69.3 %) had post primary education and 46.8% were siblings to their intended recipients. The donor dropout rate was 42.3%, with the most common reason for donor exclusion being a medical contraindication at 52.3%. Of these, hypertension, diabetes and renal disease accounted for 24.1%. 22.4% and 29.3% respectively. Psychosocial reasons accounted for 22.5% while those excluded because of an immunological contraindication were 7.2%. Only two donors were excluded due to a surgical contraindication. Other reasons for exclusion (19.8%) were related to the intended recipient and included, recipient demise (10 donors), severe cardiovascular disease that rendered the recipient not transplantable (9 donors) or in other cases the availability of a more suitable donor (5 donors). Majority of donors (56.4%) were excluded in the early stages of the donor evaluation process (stage 1 to stage 3). Majority of the donors (75.7%) made between one to four visits prior to exclusion, while only a minority (2.7%), made greater than 8 visits before being excluded. The mean duration of time between donor enrollment and donor exclusion was 33.7 weeks with a median of 2.5 weeks. The shortest time taken before donor exclusion was less than a week with the longest duration was almost 78 weeks. CONCLUSION. In this study, we report a moderate rate of living donor drop out. The main reason for exclusion was a medical contraindication, with majority having renal disease, hypertension or diabetes