Renal diseases not transmissible via HCST
Examples:
- Congenital malformation
- Nephrectomy after injury or dysfunctional kidney (e.g. hydronephrosis from childhood)
- Polycystic kidney disease
- Nephrotic syndrome
Other conditions:
- Nephrolithiasis (kidney stones)
- Kidney donation
Individual at risk
Donor
Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)
UNACCEPTABLE if progressive disease and / or global renal function is impaired.
Guidance at CT/WORK-UP
PERMANENT DEFERRAL if progressive disease and / or global renal function substantially impaired.
Otherwise, according to clinical reasoning by the assessing physician, the donor could be eligible, temporarily unavailable or permanently deferred.
Evaluate carefully for absence of inflammatory (autoimmune or infectious) nephropathy. If there is a suspicion of an inflammatory nephropathy, but renal biopsy is not indicated, inform the requesting transplant centre and proceed with bone marrow collection only if requested (see below).
Nephrolithiasis: Assess the type of kidney stones in the available medical history, document the type of kidney stones if this information is available. Accept if fully recovered from acute event.
Justification for guidance
Use of granulocyte colony-stimulating factor has been associated with reports of acute glomerulonephritis, almost all of which have been immune complex associated.
Donors with progressive disease or impaired kidney function may be at increased risk of adverse events associated with either type of donation.
Renal diseases potentially transmissible via HCST
Condition
Chronic infectious or autoimmune diseases, for example:
- Tuberculosis
- Chronic pyelonephritis
- Chronic glomerulonephritis
- IgA nephropathy
Individual at risk
Donor / recipient
Guidance at RECRUITMENT for adult volunteer donor and maternal donor (cord blood donation)
IgA nephropathy ACCEPTABLE
Others UNACCEPTABLE
Guidance at CT/WORK-UP
Biopsy/diagnosis confirmed IgA nephropathy ACCEPTABLE for bone marrow only if condition does not impact kidney function. Inform the requesting transplant centre and proceed if requested.
Others UNACCEPTABLE, PERMANENT DEFERRAL
Justification for guidance
Donors with chronic infectious or autoimmune disease may experience exacerbations of their disease as a result of donation. In addition, there is a risk of transmission of infectious agents or autoreactive lymphocytes to the recipient.
References
- Batal I, Markowitz G, Wong W, et al. Filgrastim-induced crescentic transformation of recurrent IgG2λ GN. J Am Soc Nephrol. 2016;27(7):1911-1915.
- Chandra P, Dahiya S, Sanchez-Petitto G, et al. Acute glomerulonephritis in a hematopoietic blood stem cell donor. Clin Nephrol Case Stud. 2021;9:81-86.
- Guffroy B, Ingwiller M, Gavand P, et al. Flare of IGA glomerulonephritis under G-CSF stimulation regimen for autologous stem cell transplantation in systemic sclerosis. Rheum (Oxford). 2020;59(9):e33-e34.
- Korman A, Leiba A, Edel Y, et al. G-CSF-induced ANCA associated glomerulonephritis in the presence of silent membranous “full house nephropathy” in an altruistic bone marrow donor. Renal Failure. 2022;44(1):1499-1501.
- Nasilowska-Adamska B, Perkowska-Ptasinska A, Tomaszewska A, et al. Acute glomerulonephritis in a donor as a side effect of allogeneic peripheral blood stem cell mobilization with granulocyte colony-stimulating factor. Int J Hematol. 2010;92(5):765-768.