Living Donor Pre-Diabetes Risk Assessment — ESENeph MCQ

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HardTransplantationLiving Donor Pre-Diabetes Risk AssessmentESENeph

A 40-year-old woman is being worked up as a potential living kidney donor for her husband. Her eGFR is 95 mL/min/1.73m2, BP 124/78 mmHg, BMI 26 kg/m2, uACR <3 mg/mmol. She has a strong family history of type 2 diabetes (mother, father, and sister all affected). Her HbA1c is 42 mmol/mol (pre-diabetes). What is the MOST appropriate recommendation?

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Correct answer: C — Proceed but with additional metabolic counselling and long-term follow-up plan

KDIGO 2017 Living Donor Guidelines use a lifetime risk framework that integrates multiple factors including age, eGFR, BP, BMI, family history of kidney disease, and diabetes risk. Pre-diabetes (HbA1c 42-47 mmol/mol) combined with strong family history of T2DM elevates her post-donation metabolic risk but does not automatically exclude donation. The appropriate approach is thorough informed consent about her elevated lifetime ESKD risk post-donation, confirmation of glycaemic status with OGTT, and a commitment to robust long-term follow-up with metabolic monitoring. Blanket exclusion for family history alone is overly restrictive; proceeding without addressing the risk is inadequate.

Reference: KDIGO 2017 – Living Kidney Donor Evaluation and Care; BTS/UKKA 2018 – Living Donor Guidelines