A potential living kidney donor with prediabetes

Abstract

A 54-year-old Caucasian man wished to donate a kidney to his adult daughter, who reportedly had end-stage renal disease secondary to a glomerulonephritis of unknown origin inherited through her mother, thus ruling out any potential donors from the maternal side. As the donor and recipient transplant teams were located in separate centers, all information pertaining to the recipient was collected from the potential kidney donor himself. As a child, his daughter had received a deceased donor renal transplant, which failed for unknown reasons after 3.5 years. He was previously turned down as a donor 7 years before presentation for unknown reasons. His past medical history was significant for hyperlipidemia controlled with a statin, hypothyroidism treated with L-thyroxine, and removal of three colonic polyps 12 years before presentation. Surgical history was significant for cholecystectomy and laser-assisted in situ keratomileusis surgery. He was a nonsmoker and ingested two alcoholic drinks per day. His mother had type 2 diabetes mellitus (T2DM) and died of congestive heart failure in her eighties. On examination, body mass index was 30 kg/m2 and blood pressure was 126/85. The remainder of the examination was within normal limits. Laboratory values, shown in Table 1, were consistent with the diagnosis of impaired fasting glucose (IFG). Repeat testing showed persistence of the IFG. On the basis of this diagnosis alone, his risk of future T2DM was estimated at approximately 25% in the next 3-5 years.1 Additional diabetes risk factors included the following: obese with abdominal obesity; type 2 diabetes in first-degree relative; sedentary lifestyle. Although they technically did not meet the American Diabetes Association criteria for diabetes risk factors, the following were also highly suggestive of increased diabetes risk: hypertriglyceridemia, elevated diastolic blood pressure. Using the American Diabetes Association Diabetes Personal Health Decisions calculator2 to incorporate the potential donor's personal and family history, his 10- and 30-year risk of developing T2DM were estimated at 75 and 81%, respectively. © 2009 International Society of Nephrology.