Affiliated to research
My research since many years has focused on living donors. The published work ”Kidney donors live longer” published 1996 in Transplantation became a frequent cited papert and is still read.
Kidney living donors
My current interest is to find the correct donor to each transplant recipient. Too many donors are investigated but are denied due to medical factors. The investigation during 2014-2017 at Karolinska, Huddinge revealed that 107 donors were denied and 24% due to kidney abnormalites, most common low GFR. Maybe our requirements on renal functions are too high? Other conditions are hypertension, pathologic glucose tests, overweight.
The second reason for denial was postive crossmatch or donor specific antibodies (DSA) which was found in 19% of the cases. The new tests may be too sensitive. Earlier, DSA could be detected in people having their second transplantation. But now we see recipients planned for their first transplantion having antiboides. Thus, we often deny people from donating. The new STEP program with exchange of kidneys has recently started and helps donors and recipients, that could be better matched within Scandinavia. However, this is not enough.
Resarching following the kidney recipients analysing DSA and immune response parameters seem important. DSA could be detected long-term after kidney transplantation and the graft function is anyhow stable! It is still unclear how to handle that information.
Another question, that has been debated, is that the kidney donor investigations take too long time. An analysis from the years 2014 - 2019 showed that the nurse preinvestigation took 1 month, the nephrologists investigations 4.5 months and the time for the transplantsurgeons 3.3 months on the average. In all, the investigations took 8.8 months until donation and transplantation.
To find new donors like anonymous donors and publish more results about these donors seems important. Also, expanding the elderly people to donate.
I have permission from Karolinska Ethics Committee to follow up of and analyse kidney donors with kidney function and clinical parameters.
Ingela Fehrman Ekholm