[Metabolic syndrome and live kidney donor: is this syndrome a contraindication to donation?]

Abstract

Living donor kidney transplantation (KT) is the treatment of choice for end-stage renal disease patients and exhaustive assessment of the potential live kidney donor leads to successful KT in most occasions. Diabetes mellitus (DM), hypertension and obesity make up contraindications to donation because all of them are associated with postsurgical complications and future development of renal failure and cardiovascular (CV) disorders. However, it is unclear how much risk there is for individuals who donate a kidney and then develop some of these complications, which are grouped under the metabolic syndrome (MS.) Indeed, MS is a cluster of CV risk factors such as obesity, dyslipidemia, hypertension where the insulin resistance is the pathogenic mainstay. MS is an entity very prevalent in the western countries (20-30%) and has been associated with the development of CV disorders, DM and renal disease. Thus, it is crucial to detect MS before living donation in order to avoid these complications in the long-term. Regardless of clinical criteria to diagnosis MS, both oral glucose tolerance test and HbA1c levels may be useful clinical tools for unmasking MS before donation. Moreover, determination of insulin resistance by HOMA could help to achieve this objective. This review will outline the next issues: 1) frequency of MS in the general population (potentially, living kidney donor); 2) the impact of MS on DM, renal function and other CV complications; 3) assessment of living donor to unmask MS before donation; and 4) interventions on risk factors for minimizing MS-related threatening complications in the long-term. In any case, if MS is detected prior to donation, prophylactic and therapeutic measurement should be performed to avoid its progression. By contrast, MS could be considered a contraindication to donation.