LAUSR

There is variability among transplant centers in the acceptance of living donor candidates with well-controlled hypertension. Increased gestational hypertension and preeclampsia are more common in donors than in the general population especially if the donor is hypertensive at baseline. The purpose of this survey is to form a consensus about the evaluation of marginal live kidney donors (women and men) with hypertension. This is a cross-sectional survey of nephrologists and transplant surgeons about Suitability and Acceptance of The Marginal live Kidney Donors. The survey was sent to nephrologists in different countries and it was also distributed through AST & ERA-EDTA. A total of 122 practitioners from 22 countries responded to the survey. Of those, (N=96, 80.2%) were nephrologists and (n=23 19.83%) were transplant surgeons. The majority (45%) of the respondents were from USA. Most of the respondents (N=85, 69.7%) would allow a multiparous female (MPW) with mild and controlled hypertension (on a single blood pressure medication) who is not planning to have more children to donate. The rest would either advise against donation unless there is no alternative donor (n=23, 18.85%), or decline it altogether (n=14, 11.5%). In contrast, more respondents would reject a primiparous donor woman (PPW) with the same clinical scenario who considers having children (n=51, 42.2%, P=0.00001 ), or accept it only if there is no alternative donor (n=46, 38.0%, P=0.0009). Furthermore, most would not allow donation of a 20 years old male ( M) with an apparent white coat hypertension if his 24-hour ambulatory blood pressure monitoring shows non-dipping nocturnal pattern (n=67, 54.9%), or only accept it if there is no alternative donor (n=36, 29.5%). When comparing the rejection rate among the three donors: 11% for MPW, 41% for PPW and 54% for M. (P = 0.0001 for MPW vs PPW; P=0.00001 for MPW vs M; P=0.04 for PPW vs M). Most of the nephrologists and transplant surgeons will clear mulptiparous women with mild and controlled hypertension for kidney donation as long as there no further plans for pregnancy. However, the majority of respondents will not clear a hypertensive primiparous due to the increased risk of gestational hypertension and preeclampsia after kidney donation. Most would be also reluctant to accept very young male donors if they show indicators of higher risk of developing hypertension in future.