Introduction: Nephrolithiasis is a health problem that requires careful assessment when evaluating living kidney donor candidates, as it can have long-term effects on renal function. The absence of a universally accepted standard guideline for kidney donor candidates diagnosed with urinary stone disease is evident. Here, in this retrospective analysis, we investigated the incidence of symptomatic urinary stone disease among kidney donors who had a kidney stone diagnosed during routine preoperative evaluation and were chosen to donate according to our nephrolithiasis algorithm.
Method: A retrospective chart review was performed on kidney donors who were operated on between March 2007 and March 2017. The demographic data, follow-up nephrology notes, and CT scan findings of the kidney donors with nephrolithiasis were retracted. All donors with a urinary stone found on a CT scan were managed according to our institutional guidelines, as illustrated below (Figure).

Results: Out of 1444 patients who underwent donor nephrectomy, a subset of 48 patients (3.3%) had a kidney stone diagnosis as detected on the CT scan performed during the preoperative assessment. The mean age of these donors was 45.9 ± 11.7 years. Of them, 22 (45.8%) were male, and 26 (54.2%) were female. The mean body mass index (BMI) was calculated to be 26.5 ± 4. In 31 cases (64.5%), the kidney stone was located on the left kidney, while in 17 donors (35.5%), it was found on the right side. Only the kidneys with stones were donated, and the average diameter of the stones was 3 ± 1.7 mm. The calculated average duration of follow-up was 10.1 ± 2.5 years. According to the nephrology follow-up notes, there have been no reported instances of kidney stone recurrence at the remaining kidneys or any mention of stone passage, hematuria, or other symptoms indicative of urolithiasis among kidney donors with the stone disease during their routine yearly clinical controls. 
Conclusion: Several guidelines exist for the preoperative assessment of kidney donors with kidney stones; nevertheless, it is crucial to note that these guidelines lack evidence-based support. The available data regarding the long-term ramifications of kidney donors with kidney stones is also still limited. We believe that meticulous preoperative evaluation and close follow-up with these donors after surgery are the keys to long-term safety.