This is primarily with a view to providing sufficient residual (donor) renal function post-donation. A separate consideration

is that the donated kidney needs to provide sufficient function for the transplant recipient. While long-term outcomes of renal Rapamycin donors reported in the literature have generally been good, these reports are from an era when more stringent criteria for organ donors were used, and selection criteria generally ensured healthy donors with normal renal function. Studies of donors with reduced renal function are limited.1 The increasing success and safety of transplantation (including for marginal recipients), the associated widening gap between transplant and dialysis outcomes, and the lengthening waiting lists for cadaveric kidneys have led to a greater demand for donors. In turn, this has led to a greater willingness to consider and accept donors with isolated ABT-199 datasheet medical abnormalities (IMA) (e.g.

hypertension, obesity and lower GFR) and older age.2 Concerns with respect to living donors with lower GFR are the following: (i)  Outcome for the recipient: Transplant GFR is an important determinant of graft and patient outcome post kidney transplantation.3–5 Lower GFR is likely to be associated with poorer outcome but is still almost always superior to outcome on dialysis. *There may be additional considerations in relation to reduced renal mass such as mineral/bone metabolism and anaemia. The following factors also warrant consideration: (i)  GFR normally decreases with age. Renal function is most widely assessed by GFR, either measured or estimated. An accurate measure of GFR can be undertaken using low molecular weight markers of kidney function such as inulin, iohexol, technetium (labelled DTPA) or labelled EDTA, however, the methods are time-consuming, expensive and generally not available.10 In addition to the direct measurement of GFR, there are several methods for estimating GFR. The measurement of Decitabine in vivo 24 h creatinine clearance tends to

underestimate hyperfiltration and overestimate low GFR levels and is subject to errors in urine collection unless great care is taken. The regular measurement of serum creatinine levels is easy to perform and is currently the most common method. However, because creatinine is invariably reabsorbed by the renal tubules, serum creatinine and creatinine clearance measurements tend to underestimate the GFR in the context of hyperfiltration and overestimate the GFR in the context of hypofiltration.11 Estimation of GFR by serum creatinine-based equations such as the CG or MDRD equations are commonly used for chronic kidney disease (CKD) screening, however, the application in healthy populations and for the screening of potential living kidney donors is less clear. For example, the Australasian Creatinine Consensus Working Group currently recommend that eGFR values greater than 90 mL/min per 1.