Outcomes of Live Kidney Donors Who Develop End-Stage Renal Disease

Abstract

Background Kidney donors can develop ESRD after donation, but the outcomes of those who do remain poorly characterized. Methods Using USRDS and SRTR data, we compared access to kidney transplantation (KT), time from ESRD to listing, time from listing to KT, and post-KT graft failure and death between donors and matched nondonors with ESRD. Results Among 99 donors between April 1994 and November 2011 who developed ESRD, 78 initially received dialysis (of whom 37 listed for KT, 2 received live donor KT without listing, and 39 never listed for or received a KT), 20 listed preemptively (of whom 19 were subsequently transplanted), and 1 received a preemptive live donor KT without listing or ever receiving dialysis. Donors were listed earlier (median time-to-listing 17 months versus 120 for nondonors; p<0.001), received KT earlier (median waiting-time 2.8 months versus 21.5 for nondonors; p<0.001), and received 13% live donor, 87% standard criteria, and 0% expanded criteria deceased donor KT (39%, 50%, and 11% in nondonors). Post-KT graft failure (adjusted hazard ratio [HR], 1.9; 95% confidence interval [CI], 0.9 to 4.1; p=0.1) and patient mortality (HR, 0.7; 95% CI, 0.2 to 2.4; p=0.5) were comparable in donors and nondonors. Conclusions Our finding that 39 of 99 donors who developed ESRD never listed for a transplant warrants further study to ascertain why these donors with ESRD never gained access to the waiting list.

A Case-Based Analysis of Whether Living Related Donors Listed for Transplant Share ESRD Causes with Their Recipients

“…Even if the OPTN database were complete, we would emphasize that an accurate analysis of donor ESRD (and any potential links to recipient ESRD causes) should tally all donors with ESRD regardless of treatment modality (transplant, dialysis, and no treatment), ideally including those without access to care and those who donated in the United States but live overseas. Because these harder-to-reach donors may also be more vulnerable (poorer and more geographically remote), their outcomes are particularly relevant in order to understand and discuss the risk of developing ESRD postdonation (22). Although some of this information can be obtained by combining searches from other databases, the ideal solution is the establishment of a national donor database (23).…”

Age alone is not a contraindication to kidney donation: Outcomes of donor nephrectomy in the elderly

“…groups have reported a higher risk of ESRD on long-term follow-up in donors when compared to healthy control population who would have been eligible for kidney donation 28,29. In a subgroup analysis of >60-years-old, Muzaale et al reported a cumulative ESRD incidence of 70.2 (95% CI, 30.4-161.8) per 10 000 at 15 years postdonation, which was higher than that for younger donors.…”

KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors

“…Last, in the US context, we recommend that the counseling of donors about the small increased risk of kidney failure after donation should also include information about former donors receiving very high priority in the deceased donor list in the unlikely event that they develop kidney failure. 23,24 Compatibility…”