1. Live Donor Registry Steve Chadban

2. www.anzdata.org.au Transplant numbers

3. www.anzdata.org.au Impaired kidney function Calculated GFR (body surface area adjusted) Median and interquartile range

4. www.anzdata.org.au Age25-3435-4445-5455-6465-7475+ IFG % 2.05.27.28.77.66.8 IGT % 3.46.510.015.221.223.2 New DM 0.11.42.96.68.512.1 Known DM 0.21.03.36.59.410.9 Prevalence of abnormal glucose metabolism* in Australian Adults, AusDiab 1999-2000. *WHO criteria after OGTTDunstan etal. Diabetes Care 2002;25:829-34

5. www.anzdata.org.au Patients who have undergone unilateral nephrectomy who are obese: Praga et al. KI 2000;58:2111

6. www.anzdata.org.au Risk of ESKD after kidney donation - USA Kidney donors on waiting list 0.15% –Incidence white < 50 0.04% Black <500.2% –Significantly greater than risk in age matched pop gen popdonor White 30-390.0080.1 Black0.040.52 –Cause of ESRF FSGS DM –20-50% have a family Hx of DM –Age at donation38.5y –Age at ESRF49 Connie Davis, ATC 2005

7. www.anzdata.org.au Pre-donation data Commenced 2004, data 2004-6 = 764 (>95%) Age 48+/-11yrs, 25%>57, 18%>60 F 56%, M 44%, 89% caucasian 62% related, 22%spousal, 15% other LURD SCr 78+/-15 umol/L, 25%>88 GFR 112 +/-30, GFR<96 in 25% –Nuc GFR (n=329) 117+/-23, 25% <100, 2%<80 –MDRD or CrCl (n=250) 107 +/-36, 25%<76, 29%<80

8. www.anzdata.org.au Pre-donation data SCr 78+/-15 umol/L, 25%>88 GFR 112 +/-30, GFR<96 in 25% –Nuc GFR (n=329) 117+/-23, 25% <100, 2%<80 –MDRD or CrCl (n=250) 107 +/-36, 25%<76, 29%<80 Proteinuria (n=627 or 82%) –Mean 0.12g/day –>0.20g/d in 21 (3.3%)

9. www.anzdata.org.au Pre-donation data BMI 26 +/-4.0 – 16% 30-35, 2.3% > 35 Diabetes – known (10) + OGTT (14) = 24 (3%) –OGTT reported 70%, 81% normal, 17% IFG, 2% DM –+FHx in 21% –2 diabetic donors with BP>140/90 BP 125/75 +/- 13/9 –Systolic BP >140 in 6%, DBP >90 in 2.7%, >140/90 in 1.6% Smoking – 8.3%

10. www.anzdata.org.au Follow-up post-nephrectomy 1 year = 23%, 2 year = 15% 1yr follow-up (n=235): –SBP 124±13 –DBP 75±8 –New hypertension 10% –SCr 108±23 –MDRD 59±12 – 25% <51 –PCR (n=75) 5.6±5.5 –Reported problems (n) – elevated SCr (6), proteinuria (3), pain (1), IgA (1), retroperitoneal fibrosis (1).

11. www.anzdata.org.au Key Issues Follow-up – non-mandated but crucial! Current follow-up data not useful Frequency of ESKD among donors, mortality Outcomes at extremes of GFR –Hyperfiltration – GFR>140 with low-grade proteinuria –Low baseline GFR – typically elderly, impact on CVS outcomes Proteinuria – development, evolution, relationship to BMI, diabetes BP – kidney, CVS and BP outcomes among hypertensives, smokers Controls