Transplant Library
199 results
Highlighted Expert Reviews
Transplant Rev (Orlando). 2022 Dec 23;37(1):100746 doi: 10.1016/j.trre.2022.100746.
Am J Transplant. 2022 Oct;22(10):2360-2380 doi: 10.1111/ajt.17122.
Br J Surg. 2022 Jul 15;109(8):671-678 doi: 10.1093/bjs/znac114.
  • Bailey PK
  • Caskey FJ
  • MacNeill S
  • Ashford R
  • Pryce L
  • et al.
Pilot Feasibility Stud. 2023 Jan 20;9(1):13 doi: 10.1186/s40814-023-01241-1.

The UK's living-donor kidney transplant (LDKT) activity falls behind that of many other countries internationally, with less than 20% of those eligible receiving a LDKT each year. Certain individuals with kidney disease in the UK appear to be particularly disadvantaged in accessing a LDKT; the most socioeconomically deprived people with kidney disease are 60% less likely to receive a LDKT than the least deprived. Improving equity in living-donor kidney transplantation has been highlighted as an international research priority.


This feasibility trial was designed to determine the feasibility of delivery and acceptability of a multicomponent intervention designed to improve access to living-donor kidney transplantation. The intervention comprises three main components: (i) a meeting between a home educator and the transplant candidate for a dedicated discussion about living-donor kidney transplantation, living kidney donation and potential donors; (ii) a standardized letter from a healthcare professional to a candidate's potential donors and (iii) a home-based education and family engagement session including two home educators, the transplant candidate and their family. The primary objectives are to establish the feasibility (i) of delivering the developed intervention in existing care pathways and (ii) of undertaking a randomised controlled trial of the intervention. A mixed-methods parallel process evaluation will investigate the acceptability, implementation and mechanisms of impact of the intervention. The trial is based at two UK hospitals: a transplanting hospital and a non-transplanting referral hospital. Individuals are eligible if they are ≥ 18 years old, are active on the kidney transplant waiting list or have been referred for transplant listing and do not have a potential living-donor undergoing surgical assessment. Randomisation will be undertaken with concealed allocation. Participants will be randomly allocated 1:1 to (i) the intervention or (ii) usual care, stratified by site to ensure a balance in terms of local differences. Minimisation will be used to ensure balance in sex, age group and socioeconomic strata, with probability weighting of 0.8 in order to reduce predictability. The primary outcomes are recruitment (% of those eligible and invited who consent to randomisation) and retention (% of participants completing follow-up).


Findings will inform the design of a future fully powered, randomised controlled trial to formally evaluate the effectiveness of the intervention at improving equitable access to living-donor kidney transplantation.


ISRCTN Registry ISRCTN10989132 Applied 30/10/20.

  • Alvarado F
  • Cervantes CE
  • Crews DC
  • Blanck J
  • Al Ammary F
  • et al.
Am J Transplant. 2022 Jul;22(7):1737-1753 doi: 10.1111/ajt.17017.

We conducted a systematic review to assess outcomes in Hispanic donors and explore how Hispanic ethnicity was characterized. We searched PubMed, EMBASE, and Scopus through October 2021. Two reviewers independently screened study titles, abstracts, and full texts; they also qualitatively synthesized results and independently assessed quality of included studies. Eighteen studies met our inclusion criteria. Study sample sizes ranged from 4007 to 143,750 donors and mean age ranged from 37 to 54 years. Maximum follow-up time of studies varied from a perioperative donor nephrectomy period to 30 years post-donation. Hispanic donors ranged between 6% and 21% of the donor populations across studies. Most studies reported Hispanic ethnicity under race or a combined race and ethnicity category. Compared to non-Hispanic White donors, Hispanic donors were not at increased risk for post-donation mortality, end-stage kidney disease, cardiovascular disease, non-pregnancy-related hospitalizations, or overall perioperative surgical complications. Compared to non-Hispanic White donors, most studies showed Hispanic donors were at higher risk for diabetes mellitus following nephrectomy; however, mixed findings were seen regarding the risk for post-donation chronic kidney disease and hypertension. Future studies should evaluate cultural, socioeconomic, and geographic differences within the heterogeneous Hispanic donor population, which may further explain variation in health outcomes.

  • Bin Mohamed Ebrahim ME
  • Singla A
  • Yao J
  • Laurence JM
  • Wong G
  • et al.
Transplant Rev (Orlando). 2022 Dec 23;37(1):100746 doi: 10.1016/j.trre.2022.100746.
CET Conclusion
Reviewer: Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This systematic review explores the published data regarding living kidney donors with a history of renal stones. The authors identified 14 studies of 432 patients, identifying just one patient with a reported stone-related event. However, the identified studies were limited in quality and detail, and the average follow-up was just 21.1 months. Review methodology is good, with protocol registration, thorough literature search strategies and quality assessment. The authors make the best of the literature available with a comprehensive and well-written summary, but as they point out, there is significant risk of publication bias and under-reporting. More robust long-term registry data is required to truly quantify the risk to donors with existing stone disease.
Study Details
Aims: This study aimed to investigate the outcomes of kidney donors with a prior history of nephrolithiasis following donation.
Interventions: A literature search was conducted on Ovid and Embase. Eligible studies were selected by two independent reviewers. The Newcastle-Ottawa scale was used to assess the quality of the included studies.
Participants: 14 studies were included the review.
Outcomes: The primary outcome was stone-related event including stone-formation following donation, stone-induced obstruction, acute renal failure and sepsis. The secondary outcomes included short-term (≤30 days) and long-term (≥12 months) renal function.
Follow Up: N/A

The clinical outcomes of kidney donors with a prior history of nephrolithiasis are poorly defined. We conducted a systematic review assessing the post-donation clinical outcomes of kidney donors with a history of nephrolithiasis. Electronic databases (Ovid and Embase) were searched between 1960 and 2021 using key terms and Medical Subject Headings (MeSH) - nephrolithiasis, renal stones, renal transplantation and renal graft. Articles included conference proceedings and journal articles and were not excluded based on patient numbers. Primary outcome was donor stone-related event. Secondary outcomes were renal function upon follow-up or post-operative nephrectomy complications. In summary, 340 articles were identified through database search. We identified 14 studies (16 cohorts) comprising 432 live donors followed up for a median of 26 months post live kidney donation. Six donors donated the stone-free kidney whilst 23 live donors had bilateral stones. Mean stone size was 4.2 ± 1.4 mm (1-16) with average follow up duration of 21.1 months (1-149). Twelve studies provided primary outcome (n = 138 patients) and eight (n = 348) for secondary outcomes. One donor had a stone-related event upon follow up. A total of 195 patients had eGFR <60 upon follow up. However, they were not significantly different when compared to renal function of live donors that didn't have pre-donation nephrolithiasis. Many of the studies couldn't provide long term follow up, coupled with limited data regarding the nature of the pre-donation stone disease. In conclusion, this systematic review shows that we have very limited information upon which to base recommendation regarding pre-donation risk of post-donation complications. Longer term follow up is required and lifelong follow up with live donor registries will aid further understanding.

  • Pippias M
  • Skinner L
  • Noordzij M
  • Reisaeter AV
  • Abramowicz D
  • et al.
Am J Transplant. 2022 Oct;22(10):2360-2380 doi: 10.1111/ajt.17122.
CET Conclusion
Reviewer: Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This systematic review summarises the literature and guidelines relating to pregnancy following living kidney donation. The authors identified 16 studies reporting on 1399 post-donation pregnancies. Whilst the risk of pre-eclampsia increased post-donation, it is in keeping with an unselected general population. No difference was found in risk of other pregnancy or foetal complications. Guidelines were found to be generally consistent in advice. Methodology appears good, with well-described searches across a number of databases and screening by 3 reviewers. Risk of bias was assessed with the Robins-I tool and found to be low-moderate in most studies. Of note, studies were published over a long period (35 years) so it is perhaps not clear how relevant results of early studies are to today’s practice. Overall, the authors graded the certainty of evidence in risk of hypertension and pre-eclampsia as “low” and for other foetal outcomes as “very low”, reflecting the quality and size of the underlying evidence. This paper provides a very good summary of the evidence (and limitations thereof) regarding post-donation pregnancy.
Study Details
Aims: The aim of this study was to identify all available evidence investigating pregnancy complications post-living kidney donation, and to compare the quality and consistency of guidelines focusing on pregnancy in living kidney donors.
Interventions: A literature search was conducted on Embase, PubMed, MEDLINE, society webpages and guideline registries. Three independent reviewers performed the initial screening of study titles and abstracts. Eligibility assessment of full-text articles and data extraction were carried out by two independent reviewers. The methodological quality of the included studies were assessed using the Risk Of Bias In Non-randomized Studies of Interventions (ROBINS-I) tool.
Participants: 16 studies were included in the review.
Outcomes: The main outcomes of interest were post-donation pregnancy complications, and the risk of adverse maternal, fetal and neonatal outcomes.
Follow Up: N/A

Understanding and communicating the risk of pregnancy complications post-living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post-donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English-language publications published up until December 18, 2020. Ninety-three articles were screened from which 16 studies were identified, with a total of 1399 post-donation pregnancies. The outcome of interest, post-donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre-eclampsia increased from ~1%-3% pre-donation (lower than the general population) to ~4%-10% post-donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post-donation and pre-donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post-donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post-donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.

  • Lim WH
  • Chan KE
  • Ng CH
  • Tan DJH
  • Tay PWL
  • et al.
PLoS One. 2022 Dec 30;17(12):e0277792 doi: 10.1371/journal.pone.0277792.

Anonymous live organ donors or unspecified donors are individuals willing to be organ donors for any transplant recipient with whom they have no biological or antecedent emotional relationship. Despite excellent recipient outcomes and the potential to help address organ scarcity, controversy surrounds the unconditional act of gifting one's organs to an unrelated recipient. This qualitative systematic review provides insights into the first-hand experiences, motivations, and challenges that unspecified donors face.


A systematic search was conducted on Medline, Embase, CINAHL, PsycINFO, and Web of Science database for qualitative literature regarding unspecified living donors' motivations and experiences in liver and kidney transplantation. An inductive thematic analysis was conducted to generate themes and supportive subthemes.


12 studies were included. The four major themes were (i) motivations, (ii) perception of risks, (iii) donor support, and (iv) benefits of donation. Unspecified donors demonstrated a deep sense of social responsibility but tended to underestimate health risks in favour of benefits for recipients. Despite the lack of emotional support from family and friends, the decision to donate was a resolute personal decision for donors. Majority benefitted emotionally and did not express regret.


This qualitative review bridges the gap in literature on unspecified living donor psychology and provides a comprehensive understanding of the decision-making matrix and experiences of donors.

  • Marcus K
  • Berner D
  • Hadaya K
  • Hurst S
Transpl Int. 2023 Feb 2;36:10913 doi: 10.3389/ti.2023.10913.

The objective of this study was to investigate reasons for or against anonymity that are pertinent to kidney paired donations (KPD). We conducted a systematic review of reasons using PubMed and Google Scholar until May 2022 and through snowballing. Inclusion criteria were publications that: 1) discussed organ donation anonymity; 2) was peer-reviewed; 3) presented at least one reason on anonymity. Exclusion criteria: 1) not published in a scientific journal; 2) grey literature and dissertations. Four researchers independently reviewed and selected papers based on the criteria, extracted text passages and coded them into narrow and broad reason types, selected reasons that were valid for kidney paired donations. 50 articles were included, 62 narrow reasons (n = 24 for; n = 38 against) and 13 broad reasons were coded. Broad reasons were: protection against harm, general benefits, gratitude, curiosity, unrealistic to implement, fundamental rights, respect people's wishes, professional neutrality, timing is important, information disclosure, altruism, reciprocity and donation pool. We did not find reasons that justify legal prohibition of donor-recipient interactions for KPD, if they consented to meet. Professional counselling, follow-up and careful evaluations to prevent potential harm.

  • Gruessner RWG
Transplant Proc. 2022 Sep;54(7):1944-1953 doi: 10.1016/j.transproceed.2022.05.022.

A safe, reproducible and standardized surgical technique for intestinal procurement and transplantation from a living donor (LD) was introduced in 1997 and has been used in the majority of cases since. The key principles are: 1. procurement of 180-200 cm of distal ileum in adults (about 60-150 cm in pediatric recipients depending on age and weight) on a vascular pedicle comprising the LD ileocolic vessels or terminal branches of the superior mesenteric vessels, 2. the terminal ileum (30-40 cm of the most distal ileum), the ileocecal valve and the cecum remain with the donor to not interfere with B12-absorption and bowel transit time, 3. systemic venous drainage with anastomoses between the LD ileocolic vessels and the recipient's infrarenal aorta and vena cava, and 4. restoration of recipient bowel continuity through proximal anastomosis and distal graft ileostomy for biopsy access and graft monitoring. Recipients of a successful LD intestinal transplant become total parenteral nutrition (TPN)-independent within a few weeks posttransplant. LD vs deceased donor (DD) intestinal transplants can be performed in a more timely fashion. Hence, LD (in contrast to DD) intestinal transplants are also pre-emptive procedures in patients with advanced, but still reversible, TPN-induced liver disease and help reduce the wait-list mortality for combined DD intestinal and liver transplants. Life-saving combined LD intestinal and liver transplants, albeit rare, have also been successfully performed either simultaneously or subsequently. There have been no reported deaths or major complications of living intestinal donors. A better metabolic profile has been reported in some donors post-donation. In total, 85 documented LD intestinal transplants have been performed worldwide at over 20 different transplant centers in 12 different countries. In about 70 transplants, the standardized technique was used. There has been no difference in outcome between LD vs DD intestinal transplants. Long-term studies have shown that > 10 year of graft function is not uncommon. Since the introduction of the standardized surgical technique, LD intestinal transplantation has evolved from an experimental to an established and standardized procedure.

  • Dixon SN
  • Naylor KL
  • Yohanna S
  • McKenzie S
  • Belenko D
  • et al.
Can J Kidney Health Dis. 2022 Nov 22;9:20543581221131201 doi: 10.1177/20543581221131201.

Enhance Access to Kidney Transplantation and Living Kidney Donation (EnAKT LKD) is a quality improvement intervention designed to enhance access to kidney transplantation and living kidney donation. We conducted a cluster-randomized clinical trial to evaluate the effect of the intervention versus usual care on completing key steps toward receiving a kidney transplant.


To prespecify the statistical analysis plan for the EnAKT LKD trial.


The EnAKT LKD trial is a pragmatic, 2-arm, parallel-group, registry-based, open-label, cluster-randomized, superiority, clinical trial. Randomization was performed at the level of the chronic kidney disease (CKD) programs (the "clusters").


Twenty-six CKD programs in Ontario, Canada.


More than 10 000 patients with advanced CKD (ie, patients approaching the need for dialysis or receiving maintenance dialysis) with no recorded contraindication to receiving a kidney transplant.


The trial data (including patient characteristics and outcomes) will be obtained from linked administrative health care databases (the "registry"). Stratified covariate-constrained randomization was used to allocate the 26 CKD programs (1:1) to provide the intervention or usual care from November 1, 2017, to December 31, 2021 (4.17 years). CKD programs in the intervention arm received the following: (1) support for local quality improvement teams and administrative needs; (2) tailored education and resources for staff, patients, and living kidney donor candidates; (3) support from kidney transplant recipients and living kidney donors; and (4) program-level performance reports and oversight by program leaders.


The primary outcome is completing key steps toward receiving a kidney transplant, where up to 4 unique steps per patient will be considered: (1) patient referred to a transplant center for evaluation, (2) a potential living kidney donor begins their evaluation at a transplant center to donate a kidney to the patient, (3) patient added to the deceased donor transplant waitlist, and (4) patient receives a kidney transplant from a living or deceased donor.


Using an intent-to-treat approach, the primary outcome will be analyzed using a patient-level constrained multistate model adjusting for the clustering in CKD programs.


The EnAKT LKD trial period is November 1, 2017, to December 31, 2021. We expect to analyze and report the results once the data for the trial period is available in linked administrative health care databases.


The EnAKT LKD trial is registered with the U.S. National Institute of Health at (NCT03329521 available at


Version 1.0 August 26, 2022.

  • Jang HY
  • Im HY
  • Nam HJ
Res Nurs Health. 2022 Dec;45(6):693-706 doi: 10.1002/nur.22273.

As living liver transplantation has become a standard treatment method with a high success rate, many studies have investigated the experiences of living liver donors; however, their results have not been integrated. This qualitative meta-synthesis aimed to explore the life experiences of living liver donors to provide an in-depth understanding of meaningful common experiences. A comprehensive search on qualitative studies published in English or Korean was conducted in October 2021. The PRISMA statement was used for reporting each phase of the literature search, and MAXQDA2020 software was used for data analysis. Data synthesis was conducted using the three-step thematic synthesis method suggested by Thomas and Harden. Ten articles met the inclusion criteria. The analysis revealed five main themes: "Becoming an earnest donor," "Transitioning from a potential donor to an actual donor," "Difficulties in returning to normal life," "Re-examining the meaning of donation," and "Wishes for prospective donors." The study emphasizes that living liver donors need medical attention and intervention from multilateral perspectives as well as the need for systematic change in the society to enhance support for donors. This review provides comprehensive insights on how individuals became the living liver donor and the important aspects of living donation and other considerations in an integrated manner. Transplant teams, including nurses and coordinators, should have a comprehensive understanding of physical, psychological, and social experiences of donors ranging from decision-making to post donation health management.

  • Bellini MI
  • Nozdrin M
  • Pengel L
  • Knight S
  • Papalois V
Br J Surg. 2022 Jul 15;109(8):671-678 doi: 10.1093/bjs/znac114.
CET Conclusion
Reviewer: Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford
Conclusion: This systematic review and meta-analysis aimed to investigate the impact of donor age, sex, body mass index and ethnicity on the outcome for living kidney donors. Analysis of data from 31 observational studies demonstrated inferior outcomes in male donors, and those with a BMI greater than 30 kg/m2. African donors were found to be more likely to develop renal failure in the long-term than younger donors. Whilst some of the findings are perhaps not too surprising (reflecting the same outcomes in the general population), these data do help in the personalisation of risk assessment for donors and highlight the importance of robust follow-up for higher risk groups. It should be noted that the nature of the review question means that only observational data can be used, most of which is retrospective in nature and prone to high heterogeneity. Nonetheless, this represents a large analysis of the body of published literature on this topic.
Study Details
Aims: This study aimed to investigate the effect of age, sex, body mass index (BMI) and ethnicity on short and long term outcomes for living kidney donors.
Interventions: Electronic databases including Cochrane, Ovid, and Web of Science were searched. Study screening and data extraction were performed by two independent reviewers. The National Heart, Lung, and Blood Institute quality assessment tool was used to assess the methodological quality of the included studies.
Participants: 31 studies were included in the review.
Outcomes: The primary outcome was the effect of donor demographics (ethnicity, BMI, age, and sex) on kidney function. The secondary outcomes included the effect of donor demographics on the incidence of end-stage renal disease (ESRD), serum creatinine level, donor survival, incidence of proteinuria, blood pressure (BP), de novo hypertension, and surgical complications.
Follow Up: N/A

Living kidney donation risk is likely to differ according to donor's demographics. We aimed to analyse the effects of age, sex, body mass index (BMI) and ethnicity.


A systematic review and meta-analysis was undertaken of the effects of preoperative patient characteristics on donor kidney function outcomes, surgical complications, and hypertension.


5129 studies were identified, of which 31 met the inclusion criteria, mainly from the USA and Europe. The estimated glomerular filtration rate (eGFR) in donors aged over 60 years was a mean of 9.54 ml per min per 1.73 m2 lower than that of younger donors (P < 0.001). Female donors had higher relative short- and long-term survival. BMI of over 30 kg/m2 was found to significantly lower the donor's eGFR 1 year after donation: the eGFR of obese donors was lower than that of non-obese patients by a mean of -2.70 (95 per cent c.i. -3.24 to -2.15) ml per min per 1.73 m2 (P < 0.001). Obesity was also associated with higher blood pressure both before and 1 year after donation, and a higher level of proteinuria, but had no impact on operative complications. In the long term, African donors were more likely to develop end-stage renal disease than Caucasians.


Obesity and male sex were associated with inferior outcomes. Older donors (aged over 60 years) have a larger eGFR decline than younger donors, and African donors have a higher incidence of ESRD than Caucasians.