Hypertension in living kidney donation: implications for donor screening and follow-up

Kidney transplantation with a graft from a living donor is the best available treatment for patients with end-stage renal disease (ESRD), having better outcomes than transplantation with deceased graft(1). Because of a shortage of available kidneys, the selection criteria for living kidney donors have been liberalized(2) and donors with more co-morbidities, such as hypertension, are being accepted(1).

Worldwide, hypertension has an increasing prevalence in de general population(3). It is a known risk factor for renal and cardiovascular morbidity and mortality(4)(5) and many renal risk factors are independently associated with the development of hypertension, e.g. advanced age, obesity(6)(7)(8), parental hypertension, black race(10), excess sodium intake (>3000 mgd/day) (9), excess alcohol intake(10)(11), physical inactivity(8)(12), diabetes and dyslipidemia(7), personality traits and depression(13)(14) and reduced nephron number(15)(16)(17).

Transplant programs vary in the acceptance of donor candidates with pre-existent hypertension(2). No studies exist on the relation between living kidney donation and the development of de-novo hypertension after donation (NOHAD). Since reduced nephron mass may predispose hypertension, kidney nephrectomy in normotensive donors could increase the risk of developing de novo hypertension(15)(16)(17) and identifications of donors at risk is warranted.