Long-Term Consequences of Kidney Donation

Abstract

BACKGROUND The long-term renal consequences of kidney donation by a living donor are attracting increased appropriate interest. The overall evidence suggests that living kidney donors have survival similar to that of nondonors and that their risk of end-stage renal disease (ESRD) is not increased. Previous studies have included relatively small numbers of donors and a brief follow-up period. METHODS We ascertained the vital status and lifetime risk of ESRD in 3698 kidney donors who donated kidneys during the period from 1963 through 2007; from 2003 through 2007, we also measured the glomerular filtration rate (GFR) and urinary albumin excretion and assessed the prevalence of hypertension, general health status, and quality of life in 255 donors. RESULTS The survival of kidney donors was similar to that of controls who were matched for age, sex, and race or ethnic group. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, as compared with a rate of 268 per million per year in the general population. At a mean (±SD) of 12.2±9.2 years after donation, 85.5% of the subgroup of 255 donors had a GFR of 60 ml per minute per 1.73 m2 of body-surface area or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and higher body-mass index, but not a longer time since donation, were associated with both a GFR that was lower than 60 ml per minute per 1.73 m2 and hypertension. A longer time since donation, however, was independently associated with albuminuria. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic group, and body-mass index. CONCLUSIONS Survival and the risk of ESRD in carefully screened kidney donors appear to be similar to those in the general population. Most donors who were studied had a preserved GFR, normal albumin excretion, and an excellent quality of life.

Evaluating potential live-renal donors: Causes for rejection, deferral and planned procedure type, a single-centre experience

“…1,2 Recent long-term prospective data suggest that overall survival and risk of developing chronic kidney disease in kidney donors is similar to the general population. In addition, kidney donors experience excellent quality of life.…”

“…In addition, kidney donors experience excellent quality of life. 1 Although living donors represent more than half of the renal transplants performed in North America, there is still a wide gap between the need and availability of transplantable organs. Transplant centres are using several strategies to increase organ availability, including broadening medical acceptance criteria.…”

The State of U.S. Living Kidney Donors

“…Allaying some fear regarding donor risk was a recent single center study that reported survival of kidney donors was similar to that of controls matched for age, gender, and race (7).…”

“…It is known that renal reserve capacity is maintained except in those with a high BMI and old age (15), and proteinuria or albuminuria may increase over time from surgery (7,16 -20). It is also known that in mostly white donor populations, between 0.1 to 1.1% develop ESRD, roughly the same as the general population (5,7,(21)(22)(23). This information comes from identification of donors added to the UNOS transplant waitlist and does not include those starting dialysis but not listed for transplant.…”

Evaluation of Kidney Function and Structure in Potential Living Kidney Donors: Implications for the Donor and Recipient

“…In one study where kidney donors were followed for approximately 4 decades, less than 15 % of donors had a measured GFR by iohexol clearance of less than 60 mL/min per 1.73 m 2 , and none had a GFR of less than 30 mL/min per 1.73 m 2 . Approximately 13 % of kidney donors had some degree of microalbuminuria, but none of the patients had both microalbuminuria and a suboptimal GFR [30]. The rate of decline of GFR after donation remained within the expected values observed in healthy individuals, suggesting that there was no added underlying pathophysiologic process other than those observed with aging alone.…”