Donor-gifted nephrolithiasis: case-based analysis and comparative study

Maxwell Sandberg^1,*, Mark Xu¹, Randall Bissette¹, Jacob Malakismail², Niara East³, Robenson Nguyen⁴, Jackson Nowatzke¹, Robert Stratta⁵, Dean Assimos^1,6, Colin Kleinguetl¹
1 Department of Urology, Wake Forest Baptist Medical Center, Winston Salem, NC 27101, USA
2 Chicago Medical School, Rosalind Franklin University of Medicine and Science, North Chicago, IL 60064, USA
3 College of Medicine, Northeast Ohio Medical University, Rootstown, OH 44272, USA
4 Campbell School of Osteopathic Medicine, Lillington, NC 27546, USA
5 Section of Transplantation, Department of General Surgery, Wake Forest Baptist Medical Center, Winston Salem, NC 27157, USA
6 University of Alabama Birmingham, Birmingham, AL 35294, USA
* Corresponding Author: Maxwell Sandberg. Email: email

Canadian Journal of Urology https://doi.org/10.32604/cju.2025.069091

Received 14 June 2025; Accepted 04 September 2025; Published online 08 October 2025

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Abstract

Objectives: Donor-gifted nephrolithiasis—the presence of a stone in a donor kidney at the time of transplantation—is rare. Research is limited, and no consensus high-quality evidence guidelines exist, leaving selection criteria and management to individual provider discretion. We aimed to estimate the frequency and analyze patient and graft outcomes of deceased donor (DD) transplant recipients with stones in their kidneys at Wake Forest Baptist Medical Center. Methods: All DD renal transplants or patients receiving most of their care postoperatively after DD renal transplantation at our institution from 1979 to 2025 were reviewed. Stones were considered donor-gifted if discovered during transplantation or on imaging within two weeks of the transplant date. Patient, stone, and graft outcomes were followed over time. Stone size on imaging was compared between patients who were treated versus surveyed for their donor-gifted stones using an independent samples t-test. Results: Of 4723 patients who underwent DD renal transplant, eight were found to have a graft with stones at transplant (0.2%). The median stone size was 8 mm. Three (38%) patients underwent treatment for stones, and five (62%) underwent surveillance. Two (25%) patients experienced graft failure, and one of these patients received stone treatment. Conclusions: The frequency of donor-gifted nephrolithiasis is extremely low in DD transplant patients. Despite a small sample set, these results demonstrate favorable outcomes and provide support for the feasibility of intentionally performing DD renal transplantation in grafts with known stones.