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©2013 UpToDate ® Print Email Amsterdam forum guidelines for screening living potential kidney donors - 3 Live unrelated donors The current available data suggest no restriction of live kidney donation based upon the absence of an HLA match. An unrelated donor transplant is equally successful to the outcome achieved by a genetically related family member such as a parent, child, or sibling, who is not HLA identical to the recipient. Determination of cardiovascular risk The clinical predictors of an increased perioperative cardiovascular risk (for non-cardiac surgery) by the American College of Cardiology/American Hospital Association standards fall into 3 categories: major, intermediate, minor. All major predictors: unstable coronary syndromes, decompensated heart failure, significant arrhythmias and severe valvular disease are contraindications to live kidney donation. Most of the intermediate predictors: mild angina, previous myocardial infarction, compensated or prior heart failure, diabetes mellitus are also contraindications to donation; Minor predictors: older age, abnormal ECG, rhythm other than sinus, low cardiac functional capacity, history of stroke or uncontrolled hypertension warrant individual consideration. Assessment of pulmonary issues A careful history and physical examination are the most important parts of assessing risk. Routine preoperative pulmonary function testing (PFT) is not warranted for potential live kidney donors unless there is an associated risk factor such as chronic lung disease. Increased risk of post operative pulmonary complication is assoc with an FEV1 <70 percent or FVC <70 percent of predicted, or a ratio of FEV1/FVC <65 percent. Smoking cessation and alcohol abstinence Smoking cessation at least 4 weeks prior to donation is advised based on recommendations for patients undergoing elective surgical procedures. Cessation of alcohol abuse defined by DSM-3: 60 gm of alcohol/day sustained over ≥6 months should be avoided for a minimum of 4 weeks to decrease the known risk of postoperative morbidity. BP: blood pressure; ABPM: ambulatory blood pressure monitoring; GFR: glomerular filtration rate; BMI: body mass index; BSA: body surface area; CT: computed tomography; ESRD: end-stage renal disease; HLA: human leukocyte antigen.

Cessation of alcohol abuse defined by DSM-3: 60 gm of alcohol/day sustained over ≥6 months should be avoided for a minimum of 4 weeks to decrease the known risk of postoperative morbidity. BP: blood pressure; ABPM: ambulatory blood pressure monitoring; GFR: glomerular filtration rate; BMI: body mass index; BSA: body surface area; CT: computed tomography; ESRD: end-stage renal disease; HLA: human leukocyte antigen. Reproduced with permission from: Delmonico F; Council of the Transplantation Society. A Report of the Amsterdam Forum On the Care of the Live Kidney Donor: Data and Medical Guidelines. Transplantation 2005; 79:S53. Copyright © 2005 Lippincott Williams & Wilkins.