Long-term Safety of Living Kidney Donation in an Emerging Economy

Rizvi, Syed Adibul Hasan; Zafar, Mirza Naqi; Jawad, Fatema; Aziz, Tahir; Hussain, Zafar; Hashmi, Altaf; Hussain, Manzoor; Akhtar, F.; Ahmed, Ejaz; Naqvi, Rubina; Naqvi, Syed Arsalan Ahmed

doi:10.1097/tp.0000000000001075

Cited by 26 publications

(25 citation statements)

References 24 publications

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“…Understanding of the medical risks to living kidney donors is evolving, with the progressive publication of more robust long-term data (7)(8)(9). Recent evidence of small absolute increases in the risk of ESKD, hypertension, hypertension in pregnancy, and allcause mortality in donors in the three decades after donation, compared with the general or healthy population (4,7,8,(10)(11)(12)(13), reinforces the need for ongoing research and follow-up of living kidney donors.…”

Section: Introductionmentioning

confidence: 99%

Identifying Outcomes that Are Important to Living Kidney Donors

Hanson

Chapman

Gill

et al. 2018

CJASN

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Background and objectives Living kidney donor candidates accept a range of risks and benefits when they decide to proceed with nephrectomy. Informed consent around this decision assumes they receive reliable data about outcomes they regard as critical to their decision making. We identified the outcomes most important to living kidney donors and described the reasons for their choices.Design, setting, participants, & measurements Previous donors were purposively sampled from three transplant units in Australia (Sydney and Melbourne) and Canada (Vancouver). In focus groups using the nominal group technique, participants identified outcomes of donation, ranked them in order of importance, and discussed the reasons for their preferences. An importance score was calculated for each outcome. Qualitative data were analyzed thematically.Results Across 14 groups, 123 donors aged 27-78 years identified 35 outcomes. Across all participants, the ten highest ranked outcomes were kidney function (importance=0.40, scale 0-1), time to recovery (0.27), surgical complications (0.24), effect on family (0.22), donor-recipient relationship (0.21), life satisfaction (0.18), lifestyle restrictions (0.18), kidney failure (0.14), mortality (0.13), and acute pain/discomfort (0.12). Kidney function and kidney failure were more important to Canadian participants, compared with Australian donors. The themes identified included worthwhile sacrifice, insignificance of risks and harms, confidence and empowerment, unfulfilled expectations, and heightened susceptibility.Conclusions Living kidney donors prioritized a range of outcomes, with the most important being kidney health and the surgical, lifestyle, functional, and psychosocial effects of donation. Donors also valued improvements to their family life and donor-recipient relationship. There were clear regional differences in the rankings.Clin J Am Soc Nephrol 13: 916-926, 2018.

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Section: Introductionmentioning

confidence: 99%

Identifying Outcomes that Are Important to Living Kidney Donors

Hanson

Chapman

Gill

et al. 2018

CJASN

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“…Our dedicated donor follow-up clinic ensures that these complications are detected early and that remedial measures are taken. 20,21 There are certain limitations in our study. This is a single center-based study.…”

Section: Discussionmentioning

confidence: 99%

Untitled

Hamid

Khan²,

Aziz³

et al. 2018

Exp Clin Transplant

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Key words: Complications, Hypertension, Perioperative IntroductionKidney transplant is the treatment of choice for patients with end-stage renal disease (ESRD). Compared with long-term dialysis, kidney transplant procedures are cost-effective, offer improved quality of life, and confer a progressive survival benefit. 1,2 While the ESRD population continues to grow, the supply of kidneys for transplant from deceased donors is unlikely to increase significantly, resulting in a large gap between the demand for donor kidneys and supply. 3,4 Fortunately, living kidney donation has become an attractive alternative to transplants with deceased donations. With the advent of laparoscopic donor nephrectomy and constantly improving recipient outcomes, the number of living kidney donations has grown by 115% over the past decade. 5 From a recipient standpoint, living-donor transplant is regarded as superior to deceased-donor transplant in every respect. Living-donor transplant allows for a full donor evaluation before transplant, elective scheduling of surgery at the time of optimized recipient health, and a minimum graft ischemic time during the transplant operation. 6 The major downside of living-donor renal transplant is that it subjects a healthy person to unnecessary surgery, with its attendant risks and a life after surgery with reduced renal mass. Fortunately, donor nephrectomy is a relatively safe procedure. The risk of donor death is most commonly cited as 0.03%, the risk of major complications is from 0.23% to 2.1%, and the risk of minor complications is from 8.0% to 14.7%. 7,8 The aim of the present study was to evaluate the short-and long-term outcomes of living-related kidney donors in terms of biochemical parameters and postnephrectomy complications at a single center in Pakistan.

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“…Findings from multiple studies with up to 40 years of follow-up have shown no evidence of reduced survival compared with the general population, and some have reported better life expectancy (please see Supplementary Table S1 online). 7 , 8 , 9 , 10 , 11 Most are single-center reports and describe health event rates far lower than the general population, although, importantly, the control data were often derived from populations containing large numbers of subjects who would not have been fit to donate. 9 In an attempt to overcome this, Garg et al.…”

Section: Mortality and Cardiovascular Eventsmentioning

confidence: 99%

Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors

Price

Edwards

Hayer

et al. 2018

Journal of the American Society of Hypertension

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Chronic kidney disease (CKD) is a major risk factor for cardiovascular disease but is often associated with other risks such as diabetes and hypertension and can be both a cause and an effect of cardiovascular disease. Although epidemiologic data of an independent association of reduced glomerular filtration rate with cardiovascular risk are strong, causative mechanisms are unclear.Living kidney donors provide a useful model for assessing the “pure” effects of reduced kidney function on the cardiovascular system. After nephrectomy, the glomerular filtration rate ultimately falls by about one-third so many can be classified as having chronic kidney disease stages 2 or 3. This prompts concern based on the data showing an elevated cardiovascular risk with these stages of chronic kidney disease. However, initial data suggested no increase in adverse cardiovascular effects compared with control populations. Recent reports have shown a possible late increase in cardiovascular event rates and an early increase in left ventricular mass and markers of risk such as urate and albuminuria. The long-term significance of these small changes is unknown. More detailed and long-term research is needed to determine the natural history of these changes and their clinical significance.

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Long-term Safety of Living Kidney Donation in an Emerging Economy

Abstract: Long-term follow-up of donors has demonstrated end-stage renal disease in 0.6% at 25 years. Regular follow-up identified new onset of disease and allowed interventions that may have prevented adverse outcomes.

Cited by 26 publications

References 24 publications

Identifying Outcomes that Are Important to Living Kidney Donors

Identifying Outcomes that Are Important to Living Kidney Donors

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Chronic kidney disease as a cardiovascular risk factor: lessons from kidney donors

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