Living Kidney Donor Transplantation: A Single-Center Analysis of Acceptance Rate, Donor Exclusion Reasons, and Evaluation Timeline.

Abstract

Objectives: With limited deceased donor availability, living kidney donor transplantation remains the primary source of grafts in Tunisia. Strict donor selection criteria are essential to ensure donor safety and optimize recipient outcomes. We investigated the acceptance rate of living donor kidney transplant among eligible recipients and potential donors, enumerated the primary causes of donation discontinuation, and characterized the donor evaluation process at a single Tunisian transplant center.

Materials and methods: We conducted a retrospective review of 70 patients with end -stage renal disease referred for living donor kidney transplant evaluation and 82 potential related living donors assessed between January 2020 and December 2024. Donor assessments adhered to Kidney Disease: Improving Global Outcomes clinical practice guidelines. The acceptance rate was defined as the proportion of recipient-donor pairs that proceeded to donor nephrectomy and allograft transplant. We computed descriptive statistics with SPSS version 26 software.

Results: Among 82 evaluated donors, 11 (13.4 % ) completed nephrectomy and transplant, 35 (42.7 % ) required supplementary diagnostic investigations, and 36 (43.9 % ) were excluded after multidisciplinary committee review. The median number (range ) of donors assessed per recipient was 1 (1 -2 ). In the 11 successful transplants, 8 recipients (72.7 % ) received transplants from the initial donor candidate, whereas 3 recipients (27.3 % ) required sequential evaluation of 2 or more candidates. The mean duration from initial donor workup to transplant was 526.9 ± 192.0 days. Among 36 discontinued cases, donor -related factors accounted for 26 instances (72.2 % ), immunological barriers for 8 instances (22.2 % ), and recipient -related factors for 1 instance (2.8 % ). After discontinuation, 1 of 36 recipients (2.8 % ) underwent deceased -donor transplant and 11 recipients (30.5 % ) remained on the national deceased -donor waiting list.

Conclusions: The observed acceptance rate of 13.4 % reflects substantial barriers, predominantly donor -related contraindications identified during rigorous evaluation. Targeted interventions are needed to expand the donor pool in resource -constrained environments.