A meta-analysis of renal outcomes in living kidney donors

Li, Shasha; Huang, Yan-Mei; Wang, Min; Shen, Jian; Lin, Bing-Jie; Sui, Yi; Zhao, Hai-Lu

doi:10.1097/md.0000000000003847

Cited by 18 publications

(8 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…recent meta-analysis reported pooled cumulative incidence of ESRD at 1.1% (110 per 10,000) among studies that followed donors for at least 10 years postdonation. 8 However, this estimate draws on studies with varying follow-up times and of heterogeneous populations of donors from many different countries including South Africa, 9 Sweden, 10 South Korea, 11 Pakistan, 12 Singapore, 13 and Egypt 14 and, as such, may not apply to any specific patient population.…”

Section: Discussionmentioning

confidence: 99%

Quantifying Postdonation Risk of ESRD in Living Kidney Donors

Massie

Muzaale

Luo

et al. 2017

JASN

160

152

View full text Add to dashboard Cite

Studies have estimated the average risk of postdonation ESRD for living kidney donors in the United States, but personalized estimation on the basis of donor characteristics remains unavailable. We studied 133,824 living kidney donors from 1987 to 2015, as reported to the Organ Procurement and Transplantation Network, with ESRD ascertainment Centers for Medicare and Medicaid Services linkage, using Cox regression with late entries. Black race (hazard ratio [HR], 2.96; 95% confidence interval [95% CI], 2.25 to 3.89;<0.001) and male sex (HR, 1.88; 95% CI, 1.50 to 2.35; <0.001) was associated with higher risk of ESRD in donors. Among nonblack donors, older age was associated with greater risk (HR per 10 years, 1.40; 95% CI, 1.23 to 1.59; <0.001). Among black donors, older age was not significantly associated with risk (HR, 0.88; 95% CI, 0.72 to 1.09; =0.3). Greater body mass index was associated with higher risk (HR per 5 kg/m, 1.61; 95% CI, 1.29 to 2.00; <0.001). Donors who had a first-degree biological relationship to the recipient had increased risk (HR, 1.70; 95% CI, 1.24 to 2.34; <0.01). C-statistic of the model was 0.71. Predicted 20-year risk of ESRD for the median donor was only 34 cases per 10,000 donors, but 1% of donors had predicted risk exceeding 256 cases per 10,000 donors. Risk estimation is critical for appropriate informed consent and varies substantially across living kidney donors. Greater permissiveness may be warranted in older black candidate donors; young black candidates should be evaluated carefully.

show abstract

Section: Discussionmentioning

confidence: 99%

Quantifying Postdonation Risk of ESRD in Living Kidney Donors

Massie

Muzaale

Luo

et al. 2017

JASN

160

152

View full text Add to dashboard Cite

show abstract

“…The results of different studies are very heterogeneous, which is partly due to differences in the size and composition of the study groups as well as the length of follow-up [2,3]. Both urinary U-Prot and Alb are significantly increased only during the long-term course (>10 years) after DN [36]. Our study is the first to analyze the course of glomerular and tubular urinary proteins after DN over 1 year.…”

Section: Urinary Proteins and Enzymuriamentioning

confidence: 90%

Organ-Specific Monitoring of Solitary Kidney after Living Donation by Using Markers of Glomerular Filtration Rate and Urinary Proteins

et al. 2021

View full text Add to dashboard Cite

Background: Effective follow-up after living kidney donation is important for maintaining the renal function of the donor. We investigated whether the estimated glomerular filtration rate (eGFR) and urinary protein and enzyme levels can provide important information regarding the state of the remaining kidney after donor nephrectomy. Methods: Seventy-five living donations were included (prospective/retrospective) in the study. The following parameters were measured up to 1 year after donor nephrectomy: serum creatinine and cystatin C as markers of the GFR; the high-molecular-weight urinary proteins as markers of glomerular injury; and the low-molecular-weight urinary proteins and urinary enzymes as markers of tubular function. Results: One year after kidney donation, the creatinine and cystatin C values were 1.38-fold increased than their initial values, while the eGFR was 32% lower. At that time, 38% of donors had a moderate or high risk of CKD progression. The biochemical urinary glomerular and tubular kidney markers examined showed different behaviors. After a transient increase, the glomerular proteins normalized. Conversely, the detection of low-molecular-weight urinary proteins and enzymes reflected mild tubular damage at the end of the study period. Conclusions: Our findings suggest that for the evaluation of mild tubular damage, low-molecular-weight marker proteins should be included in the urine diagnostic of a personalized living kidney donor follow-up.

show abstract

“…The Chronic Kidney Disease Prognosis Consortium reported that the risk of kidney disease at 15 years after donation is 3.5-5.3 times greater than that in the control population [7]. Li et al [20] reported a pooled rate of 1.1% for ESRD, 5.7% for proteinuria, and 20.9% for microalbuminuria at >10 years following donation. A meta-analysis comprising 52 studies with follow-up for 24 years reported a significant increase in relative risk for ESRD of 8.83 (95%CI 1.02-20.93) [1].…”

Section: Long-term Outcome For Kidney Donorsmentioning

confidence: 99%

Hyperfiltration-mediated Injury in the Remaining Kidney of a Transplant Donor

Srivastava

Hariharan²,

Alon

et al. 2018

Transplantation

View full text Add to dashboard Cite

Kidney donors face a small but definite risk of end-stage renal disease 15 to 30 years postdonation. The development of proteinuria, hypertension with gradual decrease in kidney function in the donor after surgical resection of 1 kidney, has been attributed to hyperfiltration. Genetic variations, physiological adaptations, and comorbidities exacerbate the hyperfiltration-induced loss of kidney function in the years after donation. A focus on glomerular hemodynamics and capillary pressure has led to the development of drugs that target the renin-angiotensin-aldosterone system (RAAS), but these agents yield mixed results in transplant recipients and donors. Recent work on glomerular biomechanical forces highlights the differential effects of tensile stress and fluid flow shear stress (FFSS) from hyperfiltration. Capillary wall stretch due to glomerular capillary pressure increases tensile stress on podocyte foot processes that cover the capillary. In parallel, increased flow of the ultrafiltrate due to single-nephron glomerular filtration rate elevates FFSS on the podocyte cell body. Although tensile stress invokes the RAAS, FFSS predominantly activates the cyclooxygenase 2-prostaglandin E2-EP2 receptor axis. Distinguishing these 2 mechanisms is critical, as current therapeutic approaches focus on the RAAS system. A better understanding of the biomechanical forces can lead to novel therapeutic agents to target FFSS through the cyclooxygenase 2-prostaglandin E2-EP2 receptor axis in hyperfiltration-mediated injury. We present an overview of several aspects of the risk to transplant donors and discuss the relevance of FFSS in podocyte injury, loss of glomerular barrier function leading to albuminuria and gradual loss of renal function, and potential therapeutic strategies to mitigate hyperfiltration-mediated injury to the remaining kidney.

show abstract

A meta-analysis of renal outcomes in living kidney donors

Abstract: Supplemental Digital Content is available in the text

Cited by 18 publications

References 31 publications

Quantifying Postdonation Risk of ESRD in Living Kidney Donors

Quantifying Postdonation Risk of ESRD in Living Kidney Donors

Organ-Specific Monitoring of Solitary Kidney after Living Donation by Using Markers of Glomerular Filtration Rate and Urinary Proteins

Hyperfiltration-mediated Injury in the Remaining Kidney of a Transplant Donor

Contact Info

Product

Resources

About