Mid- and Long-Term Health Risks in Living Kidney Donors

O’Keeffe, Linda M; Ramond, Anna; Angelantonio, Emanuele Di

doi:10.7326/l18-0341

Cited by 32 publications

(53 citation statements)

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“…Previous single‐center and registry studies, comparing living donors to an age‐, gender‐, and ethnicity‐matched general population cohort, have shown no increased long‐term risk (Ref. ). However, living donors are highly screened before being accepted for donation; it would be ideal to compare living donor outcomes to similarly screened contemporary controls.…”

Section: Discussionmentioning

confidence: 96%

“…Similarly, with an average follow‐up of 5.5 years, Grupper et al found no difference in the incidence of new onset hypertension between donors and a healthy screened cohort. In a review and meta‐analysis of recent studies, O'Keeffe et al concluded that living donors had a small increase in diastolic blood pressure, but not an increased incidence of hypertension.…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, the Center for Disease Control and Prevention (CDC) recently reported that in the US general population, 12.7% (95% CI, 11.1‐14.5) of those 45‐64 had diabetes; 20.8% (95%CI, 18.8‐23.0) of those ≥65 . O'Keefe et al's recent meta‐analysis found that donors had no increased risk of diabetes …”

Section: Discussionmentioning

confidence: 99%

“…For a patient with end‐stage renal disease (ESRD), a living donor kidney transplant is the best treatment option; it provides better patient and graft survival rates and better quality of life than either dialysis or a deceased donor transplant. However, the living donor must undergo a major operative procedure associated with morbidity and mortality and with the potential for adverse long‐term consequences of living with a single kidney …”

Section: Introductionmentioning

confidence: 99%

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Kidney donor outcomes ≥ 50 years after donation

Keys

Jackson

Berglund

et al. 2019

Clinical Transplantation

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| INTRODUC TI ONFor a patient with end-stage renal disease (ESRD), a living donor kidney transplant is the best treatment option; it provides better patient and graft survival rates and better quality of life than either dialysis or a deceased donor transplant. However, the living donor must undergo a major operative procedure associated with morbidity and mortality and with the potential for adverse long-term consequences of living with a single kidney. [1][2][3][4][5][6][7] The first living donor transplants were done with the knowledge that some individuals born with a single kidney had a normal lifespan and that long-term follow-up (>40 years) of patients undergoing uninephrectomy for disease did not show increased morbidity or mortality. 3,8 To date, single-center and registry studies have included few living donors with true long-term follow-up. Herein, we report living donor outcomes ≥50 years postdonation. | MATERIAL S AND ME THODSOur living donor acceptance criteria have been described in detail. 9,10 Postdonation, with consent, we follow our living donors indefinitely.Living donors are contacted every 3 years and asked to provide an updated medical and psychosocial history, including development of new conditions, and send us any intervening laboratory results. At each contact, we ask about proteinuria, hypertension, and diabetes requiring treatment. Living donors not having recent laboratory results are asked to undergo a routine health checkup, including laboratory tests; alternatively, with permission, we contact their clinics for their recent history, physical examination notes, and laboratory results, including serum creatinine, glucose, urinalysis, and urinary protein measurements. For quality control regarding self-reported conditions, we cross-validate the most recent survey with previous ones. Since 2006, living donors have been asked to fill out Abstract Many living kidney donors (LDs) are young at donation; yet there are little data on long-term LD follow-up. We report on 66 LDs who donated ≥50 years ago: 22(33.3%) are still alive (current age, 78.5 ± 7.25 years); 39 (59%) died (mean age at death, 74.2 ± 12.3 years); and 5 are lost to follow-up (mean age at last contact, 68.7 ± 4.6 years). Those who died were older at donation (P < .001). Causes of death included 12 (30.8% of deaths) cardiovascular diseases, 9 (23.0%) respiratory failures, 5 (12.8%) malignancies and 4 (10.3%) infections, and 9 (23%) were unknown or miscellaneous. Forty-nine living donors (74%) developed hypertension at a mean age of 59.9 ± 14.0 years; 12 (18%) developed diabetes at a mean age of 62 ± 19.4 years;and 11 (16.7%) developed proteinuria at a mean age of 60.6 ± 18.2 years-each at a similar incidence as seen in the age-matched general population. At last follow-up, the eGFR by CKD-EPI (mean ± SD) for donors currently alive was 60.2 ± 13.4 mL/ min/1.73 m 2 ; for those that died, 54.0 ± 21.5 mL/min/1.73 m 2 ; for those lost to follow-up, 55.6 ± 7.5 mL/min/1.73 m 2 . ESRD developed in 2 (3.3%). SF-36 quality of life hea...

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Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Kidney donor outcomes ≥ 50 years after donation

Keys

Jackson

Berglund

et al. 2019

Clinical Transplantation

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“…A systematic review and meta‐analysis of short‐term outcomes for living donors did identify a significantly higher creatinine rise (not significantly for estimated GFR) in obese donors with a BMI of 30 kg/m 2 and greater . From a mid‐ and long‐term perspective, living donors are observed to have increased relative risk for ESKD (although absolute risk increase is low ) but this meta‐analysis did not differentiate according to donor BMI. A subsequent report from Locke et al .…”

mentioning

confidence: 77%

Should donor body mass index influence kidney utilization by transplant centers?

Sharif

2019

Transpl Int

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Kidney structural characteristics based on a kidney biopsy and contrast‐enhanced computed tomography in healthy living kidney donors

Nielsen

Skov

Buus

et al. 2020

The Anatomical Record

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The demands for kidney transplantations are increasing, and so is the number of live kidney donors (LKDs). Recent studies show that LKDs have an increased risk of developing end‐stage renal disease compared with healthy non‐donors. However, the knowledge about factors predicting renal disease in kidney donors is sparse. Some evidence points to increased glomerular sclerosis and kidney fibrosis, as well as a low number of glomeruli as associated with a worse renal outcome. This methodological study investigated that which estimates are obtainable with a standard kidney biopsy taken from the donated kidney during the transplantation, and a standard contrast‐enhanced computed tomography (CT) in kidney donors. CT‐scans were used to obtain total volume of the kidney and kidney cortex using the Cavalieri estimator and 2D‐nucleator. Glomerular number density in the biopsies was estimated by a model‐based method, and was multiplied by total cortex volume in order to estimate the total number of glomeruli in the kidney. Glomerular volume was estimated by the 2D‐nucleator and a model‐based stereological technique. Kidney fibrosis (point‐counting), glomerular sclerosis (evaluation of glomerular profiles), and arteriole dimensions (2D‐nucleator) were also estimated in the biopsy sections from the donated kidney. Various studies have attempted to identify predictors of renal outcome in LKDs. There is no consensus yet, and further studies are needed to elucidate if and how the estimates described in this study are associated with renal outcome in LKDs.

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Mid- and Long-Term Health Risks in Living Kidney Donors

Cited by 32 publications

References 2 publications

Kidney donor outcomes ≥ 50 years after donation

Kidney donor outcomes ≥ 50 years after donation

Should donor body mass index influence kidney utilization by transplant centers?

Kidney structural characteristics based on a kidney biopsy and contrast‐enhanced computed tomography in healthy living kidney donors

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