Can You Donate Part of a Liver With High Blood Pressure

June 02, 2021

Mayo Clinic has completed a study finding that advisedly selected individuals with hypertension tin safely donate a kidney. These results, which appeared in the March 20, 2021, event of Clinical Transplantation, significantly widen the potential kidney donor puddle.

Mayo Clinic was the starting time medical heart in the globe to accept living kidney donors with hypertension about 20 years ago. Other medical centers followed the Mayo Clinic lead several years later. Naim South. Issa, Thousand.D., a nephrologist at Mayo Clinic in Rochester, Minnesota, and 1 of the written report'south authors, says this is the outset formal written report published with intermediate- to long-term outcomes of donors diagnosed with hypertension.

Dr. Issa is confident the study's results will take an touch on. He says members of the public rarely know if they authorize as kidney donors if they accept high blood pressure. "They think we will exclude them," he says. "If nosotros now have an increasing donor pool because these individuals qualify, nosotros tin get more kidneys to patients who need them. This will save lives."

Previously, transplant physicians worried about transplanting kidneys from individuals with hypertension because of potential hereafter donor health concerns, such as kidney or cardiovascular diseases. They wanted to ensure long-term donor safety while living with only ane kidney.

Considering of these problems, many transplant centers accept considered hypertension an exclusion criterion for transplant. According to a 2022 commodity in Kidney International Reports, upward to half of U.S. transplant centers decline living kidney donors with hypertension.

The Mayo Clinic kidney transplant team researched transplantation of these kidneys because extended-criteria organs could help with the current organ shortage if proved safety and effective.

Currently, the Mayo Clinic criteria for eligible living kidney donors with high blood pressure is strict. Individuals with stage one hypertension (blood pressure 130-139/eighty-89 mm Hg) or stage ii hypertension (claret pressure 140/90 mm Hg or college) are allowed to donate a kidney if they meet the following criteria:

• Over xl years old in whites or over 45 years old in African Americans, as African Americans develop hypertension at an earlier age than whites
• Well-controlled hypertension on a maximum of 2 medications
• Absence of whatever target organ damage such every bit middle disease or proteinuria
• Normal kidney function for age

The Mayo Clinic transplant team does not accept those with astringent hypertension, defining patients with hypertension as rubber for potential kidney donation if the condition is mild or controlled. "We have to remain very selective, because the first intention is to protect the donor's futurity health," says Dr. Issa.

Later starting to accept living kidney donors with hypertension in 2002, the Mayo Clinic transplant team first published short-term donor follow-up results in 2004. No investigators outside of the Mayo Dispensary group observed living kidney donors with hypertension long-term. In the Mayo Clinic report, the investigators followed patients for an average of 10 years.

"This study'southward results were reassuring," says Dr. Issa. "The donors did well, including all categories of hypertension as defined by the more recent hypertension guidelines. None of the donors had meaning kidney disease or went to dialysis."

In the medium- to long-term follow-up, Dr. Issa and the team found that kidney part in donors labeled hypertensive did not differ from kidney function in those labeled nonhypertensive. In addition, the researchers performed biopsies at the time of kidney procurement, in which they noted that patients' hypertension did not crusade chronic kidney scarring. He indicates that all donors who had hypertension did fine over time.

Dr. Issa says he'southward not seen kidney recipients hesitate to receive kidneys from hypertensive donors, especially once they acquire patients who have hypertension cannot laissez passer the condition to the transplant recipient.

Defining hypertension

Dr. Issa points out another factor to consider related to assuasive patients with hypertension to donate kidneys: The definition of hypertension has evolved. "In the '50s and '60s, blood pressure level in the 160s range or higher was considered normal," he says, adding that the link betwixt elevated blood pressure and increased hazard of center illness was discovered by the Framingham Heart Study researchers in the late 1960s and published in a 1971 issue of American Periodical of Cardiology. "At present nosotros utilise a unlike and past far lower cutoff to define high blood pressure."

Another aspect of hypertension that has changed over time is the gilt standard of blood pressure level measurement. Rather than using a cursory, in-office, seated measurement with a sphygmomanometer, the Mayo Dispensary investigators used the gold standard of blood pressure measurement with an ambulatory blood pressure level monitor measuring all 900 trial participants for an xviii- to 24-60 minutes period. Dr. Issa mentions that Mayo Clinic is the only medical center to use this measurement to evaluate all potential kidney donors. Therefore, he believes that Mayo has done an optimal job of defining high blood pressure level.

In the U.S., the National Middle for Wellness Statistics' FastStats bear witness that 49.6% of adults age twenty or older have hypertension. The take chances of the condition increases with historic period, and Dr. Issa describes hypertension as highly prevalent later age 45.

Geography and ethnicity also play a role: Cocky-reported data on cardiovascular illness risk captured in the Center for Disease Control and Prevention's Hypertension Maps and Information Sources show that the highest U.S. prevalence is in the South. Dr. Issa notes that rates are highest in states with a higher population of African American and Hispanic individuals, as people of those ethnicities have a college prevalence of hypertension than do whites.

The development of hypertension's definition over fourth dimension has labeled even more than Americans every bit hypertensive; currently, a 130/80 score marks the get-go of hypertension.

How physicians can help

Dr. Issa suggests that physicians can contribute profoundly to finding kidneys for patients in need through educational activity: explaining to loved ones of kidney transplant-eligible patients that even if they, another family unit member or a friend has hypertension, it is not a bulwark to donation.

For more information

Merzkani MA, et al. Renal function outcomes and kidney biopsy features of living kidney donors with hypertension. Clinical Transplant. In press.

Ibrahim, HN, et al. Outcomes of hypertensive kidney donors using current and by hypertension definitions. Kidney International Reports. 2021;6:1242.

Kannel WB, et al. Systolic versus diastolic blood pressure level and risk of coronary center disease: The Framingham Study. American Journal of Cardiology.1971;27:335.

Hypertension. FastStats. National Center for Health Statistics.

High blood pressure level. Hypertension Maps and Information Sources. Centers for Disease Command and Prevention.

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Source: https://www.mayoclinic.org/medical-professionals/transplant-medicine/news/individuals-with-controlled-hypertension-can-safely-donate-a-kidney/mac-20514360

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