Trapianto renale da donatore vivente


  • Aris Tsalouchos Azienda Usl Toscana Centro, S.O.C. Nefrologia e Dialisi, Firenze II, Ospedale Santa Maria Annunziata, Bagno a Ripoli, Firenze - Italy
  • Maurizio Salvadori Professore di Nefrologia già Direttore Nefrologia e Trapianto, Azienda Ospedaliera Careggi, Firenze - Italy


Parole chiave:

AB0 incompatibility, Contraindications to renal donation, Evaluation of the living donor, Living donation


Kidney transplant is the best therapy to manage end-stage kidney failure. The main barriers limiting this therapy are scarcity of cadaveric donors and the comorbidities of the patients with end-stage kidney failure, which prevent the transplant. Living kidney donor transplant makes it possible to obviate the problem of scarcity of cadaveric donor organs and also presents better results than those of cadaveric transplant. The principal indication of living kidney donor transplant is preemptive transplant. This allows the patient to avoid the complications of dialysis and it has also been demonstrated that it has better results than the transplant done after dialysis has been initiated. Priority indications of living donor transplant are also twins and HLA identical siblings. We also have very favorable conditions when the donor is young and male. On the contrary, the living donor transplant will have worse results if the donors are over 60-65 years and the recipients are young, and this can be a relative contraindication. There is an absolute contraindication for the living donation when the recipient has diseases with high risk of aggressive relapse in the grafts: focal and segmental hyalinosis that had early relapse in the first transplant; atypical hemolytic uremic syndrome due to deficit or malfunction of the complement regulatory proteins; early development of glomerulonephritis due to anti-glomerular basement membrane antibody in patients with Alport syndrome; primary hyperoxaluria.

Extreme caution should also be taken in the evaluation of the kidney donors. The risks of developing renal failure or other complications are low if an adequate pre-donation evaluation has been made according to the international guidelines.


I dati di download non sono ancora disponibili.

Riferimenti bibliografici

Kasiske BL, Asrani SK, Dew MA, et al. The Living Donor Collective: A Scientific Registry for Living Donors. Am J Transplant. 2017;17(12):3040-3048. PMID 25626344

Matas AJ, Smith JM, Skeans MA, et al. OPTN/SRTR 2013 Annual Data Report: kidney. Am J Transplant. 2015;15(S2)(suppl 2):1-34. PMID:25626344

Organ Procurement and Transplant Network (OPTN)/United Network for Organ Sharing (UNOS). National data reports, transplants by donor type. (accessed january 28, 2021).

Gill J, Joffres Y, Rose C, et al. The Change in Living Kidney Donation in Women and Men in the United States (2005-2015): A Population-Based Analysis. J Am Soc Nephrol. 2018;29(4):1301-1308. PMID:29519800

LaPointe Rudow D, Hays R, Baliga P, et al. Consensus conference on best practices in live kidney donation: recommendations to optimize education, access, and care. Am J Transplant. 2015;15(4):914-922. PMID:25648884

Lentine KL, Patel A. Risks and outcomes of living donation. Adv Chronic Kidney Dis. 2012;19(4):220-228. PMID:22732041

Lentine KL, Kasiske BL, Levey AS, et al. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(8S)(suppl 1):S1-S109. PMID:28742762

Lentine KL, Lam NN, Axelrod D, et al. Perioperative Complications After Living Kidney Donation: A National Study. Am J Transplant. 2016;16(6):1848-1857. PMID:26700551

Organ Procurement and Transplantation Network: Policies. (accessed december 27, 2020).

Lentine KL, Kasiske BL, Levey AS, et al. Summary of Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(8):1783-1792.

Vigneault CB, Asch WS, Dahl NK, Bia MJ. Should living kidney donor candidates with impaired fasting glucose donate? Clin J Am Soc Nephrol. 2011;6(8):2054-2059. PMID:21784837

Gluecker TM, Mayr M, Schwarz J, et al. Comparison of CT angiography with MR angiography in the preoperative assessment of living kidney donors. Transplantation. 2008;86(9):1249-1256. PMID:19005407

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(6)(suppl):S53-S66. PMID:15785361

Seem DL, Lee I, Umscheid CA, Kuehnert MJ. Excerpt from PHS guideline for reducing HIV, HBV and HCV transmission through organ transplantation. Am J Transplant. 2013;13(8):1953-1962. PMID:23890284

Mağden K, Ucar FB, Velioğlu A, et al. Donor Contraindications to Living Kidney Donation: A Single-Center Experience. Transplant Proc. 2015;47(5):1299-1301. PMID:26093703

Abramowicz D, Cochat P, Claas FH, et al. European Renal Best Practice Guideline on kidney donor and recipient evaluation and perioperative care. Nephrol Dial Transplant. 2015;30(11):1790-1797. PMID:25007790

van Hardeveld E, Tong A; CARI. The CARI guidelines. Psychosocial care of living kidney donors. Nephrology (Carlton). 2010;15(suppl 1):S80-S87. PMID:20591050

Mandelbrot DA, Pavlakis M, Danovitch GM, et al. The medical evaluation of living kidney donors: a survey of US transplant centers. Am J Transplant. 2007;7(10):2333-2343. PMID:17845567

Pascual J, Abramowicz D, Cochat P, et al. European renal best practice guideline on the management and evaluation of the kidney donor and recipient. Nefrologia. 2014;34(3):293-301. PMID:24798566

Kido R, Shibagaki Y, Iwadoh K, et al. Persistent glomerular hematuria in living kidney donors confers a risk of progressive kidney disease in donors after heminephrectomy. Am J Transplant. 2010;10(7):1597-1604. PMID:20353466

Locke JE, Reed RD, Massie A, et al. Obesity increases the risk of end-stage renal disease among living kidney donors. Kidney Int. 2017;91(3):699-703. PMID:28041626

Massie AB, Muzaale AD, Luo X, et al. Quantifying Postdonation Risk of ESRD in Living Kidney Donors. J Am Soc Nephrol. 2017;28(9):2749-2755. PMID:28450534

Nalesnik MA, Woodle ES, Dimaio JM, et al. Donor-transmitted malignancies in organ transplantation: assessment of clinical risk. Am J Transplant. 2011;11(6):1140-1147. PMID:21645251

O'Keeffe LM, Ramond A, Oliver-Williams C, et al. Mid- and Long-Term Health Risks in Living Kidney Donors: A Systematic Review and Meta-analysis. Ann Intern Med. 2018;168(4):276-284. PMID: 29379948

Reese PP, Bloom RD, Feldman HI, et al. Mortality and cardiovascular disease among older live kidney donors. Am J Transplant. 2014;14(8):1853-1861.

Moody WE, Ferro CJ, Edwards NC, et al; CRIB-Donor Study Investigators. Cardiovascular Effects of Unilateral Nephrectomy in Living Kidney Donors. Hypertension. 2016;67(2):368-377. PMID:26754643

Mjøen G, Hallan S, Hartmann A, et al. Long-term risks for kidney donors. Kidney Int. 2014;86(1):162-167. PMID:24284516

Muzaale AD, Massie AB, Wang MC, et al. Risk of end-stage renal disease following live kidney donation. JAMA. 2014;311(6):579-586. PMID: 24519297

Boudville N, Prasad GV, Knoll G, et al; Donor Nephrectomy Outcomes Research (DONOR) Network. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med. 2006;145(3):185-196.

Garg AX, Prasad GV, Thiessen-Philbrook HR, et al; Donor Nephrectomy Outcomes Research (DONOR) Network. Cardiovascular disease and hypertension risk in living kidney donors: an analysis of health administrative data in Ontario, Canada. Transplantation. 2008;86(3):399-406. PMID:18698242

Lentine KL, Vijayan A, Xiao H, et al. Cancer diagnoses after living kidney donation: linking U.S. Registry data and administrative claims. Transplantation. 2012;94(2):139-144. PMID:22825543

de Weerd AE, Betjes MGH. AB0-Incompatible Kidney Transplant Outcomes: A Meta-Analysis. Clin J Am Soc Nephrol. 2018;13(8):1234-1243.

Gambaro G, Zaza G, Citterio F, Naticchia A, Ferraro PM. Living kidney donation from people at risk of nephrolithiasis, with a focus on the genetic forms. Urolithiasis. 2019;47(1):115-123. PMID:30470867

Przech S, Garg AX, Arnold JB, et al; Donor Nephrectomy Outcomes Research (DONOR) Network. Financial Costs Incurred by Living Kidney Donors: A Prospective Cohort Study. J Am Soc Nephrol. 2018;29(12):2847-2857. PMID:30404908



Come citare

Tsalouchos A, Salvadori M. Trapianto renale da donatore vivente. G Clin Nefrol Dial [Internet]. 27 marzo 2021 [citato 23 settembre 2023];33(1):34-8. Available at:



Articoli originali


Received 2021-02-22
Accepted 2021-03-02
Published 2021-03-27

Puoi leggere altri articoli dello stesso autore/i