Missing the split? Reconsidering the scope of biliary complications in the classification proposed at the BileducTx meeting

Living kidney donation (LKD) offers the best treatment for people suffering from end stage renal disease (ESRD)1.

Worldwide, the majority of transplanted kidneys come from deceased donors. This generous act is commendable, especially because it often arises from a very difficult situation for the patient’s family, for example after sudden death. However, living donation is considered truly altrustic, i.e. giving for another’s benefit. Research shows that LKD offers numerous advantages to the recipient, namely pre-emptive transplantation, with the possibility to plan the surgery in advance and less immunological and ischaemic insults, since the retrieved organ often comes from the same hospital and/or a well-matched donor. LKD is the ideal option for patients with complicated histories, such as repeated kidney transplant recipients2.

It is paramount to preserve a living donor’s health, remembering the Hippocratic principle of “First do not harm”. In the present systematic review3, we meta-analysed the risks, stratifying outcomes of interest in relation to donor demographic characteristics, to offer a valuable tool for health care staff involved with prospective donor candidates and managing their long-term follow up. Our approach aimed to shed a light on the evidence, in the context of Diversity and Inclusion, assessing each candidate on the basis of his/her personal demographic characteristics. These included ethnicity, body mass index (BMI), age, and sex. We looked at kidney function, expressed as estimated glomerular filtration rate (eGFR) adjusted for body surface area, incidence of ESRD, serum creatinine level at one year, donor survival, incidence of proteinuria, de novo hypertension, and surgical complications.

*Corresponding author: Yiren Hu (email: yirenhu@hotmail.com)

Department of General Surgery

The Third Clinical Institute Affiliated to Wenzhou Medical University

Correspondence to: Sabaretnam Mayilvaganan (drretnam@gmail.com)

Additional Professor

Department of Endocrine Surgery