Introduction:
Live donor kidney transplantation has been popularized to help mitigate the organ shortage crisis. At the time of living donor nephrectomy, living donors lose 50% of their kidney function or glomerular filtration rate (GFR). Studies have shown that in healthy living donors, the remaining kidney is able to adapt and recover 10-25% of post-donation lost GFR. GFR recovery is critical to long-term kidney health, particularly for Black Americans who disproportionately suffer from kidney disease with an incidence 2.5-times whites. To date, no study has examined whether health inequities in renal recovery post-donation exist.
Methods:
We retrospectively analyzed 100,121 living kidney donors reported to the Scientific Registry of Transplant Recipients between 1999-2021. We estimated GFR (eGFR) using the CKD-EPI 2021 equation and predicted the likelihood (logistic regression) and time (Cox regression) to recovery of 60% and 75% pre-donation eGFR. Models adjusted for age, sex, race, BMI, and pre-donation eGFR.
Results:
Blacks were 47% (aOR: 0.53, 95%CI: 0.50-0.56, p<0.001) and 43% (aOR: 0.57, 95%CI: 0.54-0.60, p<0.001) less likely to recover 60% and 75% of pre-donation eGFR, respectively, compared to their white counterparts. Moreover, the hazard ratio for time to renal recovery of 60% and 75% of pre-donation eGFR was 22% (aHR: 0.78, 95%CI 0.76-0.80, p<0.001) and 38% (aHR: 0.62, 95%CI 0.60-0.65, p<0.001) lower, respectively, than Whites.
Conclusion:
Black living kidney donors were less likely to recover pre-donation eGFR, and time to renal recovery was significantly longer than their White counterparts. These data highlight the need for enhanced living kidney donor follow-up, particularly for Black living kidney donors who are at greatest future risk of ESKD.