Quantifying Postdonation Risk of ESRD in Living Kidney Donors

Massie, Allan B.; Muzaale, Abimereki D.; Luo, Xiaobin; Chow, Eugene M.; Locke, Jayme E.; Nguyen, Anh Q.; Henderson, Macey L.; Snyder, Jon J.; Segev, Dorry L.

doi:10.1681/asn.2016101084

Cited by 152 publications

(154 citation statements)

References 17 publications

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“…3,4 The existing body of evidence, while finding slightly different results in different cohorts, has identified predonation risk factors associated with higher rates of ESRD in LKDs: black or African American race, male sex, biological relatedness to recipient, and older age, blood pressure, obesity, and eGFR (estimated glomerular filtration rate) at donation. 1,3,4,[12][13][14][15][16][17] Despite important contributions of previous research, questions remain about long-term risks of donation and how to best counsel potential LKDs. Numerous studies 4,[12][13][14][15][16][17][18][19] have found a relationship between race and risk of ESRD among LKDs, but the mechanisms responsible remain unclear.…”

Section: Introductionmentioning

confidence: 99%

“…1,3,4,[12][13][14][15][16][17] Despite important contributions of previous research, questions remain about long-term risks of donation and how to best counsel potential LKDs. Numerous studies 4,[12][13][14][15][16][17][18][19] have found a relationship between race and risk of ESRD among LKDs, but the mechanisms responsible remain unclear. Despite evidence regarding the role of APOL1 as a risk factor in people of African descent, [20][21][22][23][24][25] disparities in access to health care among racial minorities in the United States 26 raise the question of whether differences are explained primarily by genetic factors 27,28 or also by other factors, such as socioeconomic status (SES).…”

Section: Introductionmentioning

confidence: 99%

“…16,17 An issue intertwined with race in previous research is age at donation. 1,4,14,15 Another important question, however, is the safety of allowing donation by younger donors, who have higher predonation lifetime ESRD risk. 1,4,14,15 Another important question, however, is the safety of allowing donation by younger donors, who have higher predonation lifetime ESRD risk.…”

Section: Introductionmentioning

confidence: 99%

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Risk of ESRD in prior living kidney donors

Wainright¹,

Robinson²,

Wilk³

et al. 2018

American Journal of Transplantation

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We studied End-Stage Renal Disease (ESRD) in living kidney donors (LKDs) who donated in the United States between 1994 and 2016 (n = 123 526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. Two hundred eighteen LKDs developed ESRD, with a median of 11.1 years between donation and ESRD. Absolute 20-year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKDs had increased risk of ESRD if they were male (adjusted hazard ratio [aHR]: 1.75, 95% confidence interval [95%CI]: 1.33-2.31), had higher BMI (aHR: 1.34 per 5 kg/m , 95%CI: 1.10-1.64) or lower estimated GFR (aHR: 0.89 per 10 mL/min, 95% CI: 0.80-0.99), were first-degree relatives of the recipient (parent: [aHR: 2.01, 95% CI: 1.26-3.21]; full sibling [aHR: 1.87, 95%CI: 1.23-2.84]; identical twin [aHR: 19.79, 95%CI: 7.65-51.24]), or lived in lower socioeconomic status neighborhoods at donation (aHR: 0.87 per $10k increase; 95%CI: 0.77-0.99). We found a significant interaction between donation age and race, with higher risk at older ages for white LKDs (aHR: 1.26 per decade, 95%CI: 1.04-1.54), but higher risk at younger ages for black LKDs (aHR: 0.75 per decade, 95%CI: 0.57-0.99). These findings further inform risk assessment of potential LKDs.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Risk of ESRD in prior living kidney donors

Wainright¹,

Robinson²,

Wilk³

et al. 2018

American Journal of Transplantation

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“…ative might be because the risk of ESRD is increased in those related to an individual with ESRD[11][12][13][14][15][16][17][18] ; if so, unrelated donors (who have no ESRD in their families) may not be at increased risk. Two such calculators, using historical donor information, have been developed 22,39. Two such calculators, using historical donor information, have been developed 22,39.…”

mentioning

confidence: 99%

Causes and timing of end-stage renal disease after living kidney donation

Matas

Berglund

Vock

et al. 2018

American Journal of Transplantation

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End-stage renal disease (ESRD) is a risk after kidney donation. We sought, in a large cohort of kidney donors, to determine the causes of donor ESRD, the interval from donation to ESRD, the role of the donor/recipient relationship, and the trajectory of the estimated GFR (eGFR) from donation to ESRD. From 1/1/1963 thru 12/31/2015, 4030 individuals underwent living donor nephrectomy at our center, as well as ascertainment of ESRD status. Of these, 39 developed ESRD (mean age ± standard deviation [SD] at ESRD, 62.4 ± 14.1 years; mean interval between donation and ESRD, 27.1 ± 9.8 years). Donors developing ESRD were more likely to be male, as well as smokers, and younger at donation, and to have donated to a first-degree relative. Of donors with a known cause of ESRD (n = 25), 48% was due to diabetes and/or hypertension; only 2 from a disease that would have affected 1 kidney (cancer). Of those 25 with an ascertainable ESRD cause, 4 shared a similar etiology of ESRD with their recipient. Almost universally, thechange of eGFR over time was stable, until new-onset disease (kidney or systemic). Knowledge of factors contributing to ESRD after living kidney donation can improve donor selection and counseling, as well as long-term postdonation care.

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“…These estimates have been incorporated into a simple web-based risk calculator (http://www. transplantmodels.com/donesrd/) that quantifies ESKD risk over time based on single donor characteristics [14].…”

Section: Donor and Recipient Outcomes After Donationmentioning

confidence: 99%

Criteria for Living Donation from Marginal Donors: One, No One, and One Hundred Thousand

Cantarelli¹,

Cravedi²

2019

Nephron

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Context: The increasing need for kidney grafts has led to a progressive expansion in the selection criteria for deceased and living donors (LDs). While concerns regarding the use of organs from suboptimal deceased donors relate to the quality of the graft, donation from “marginal” LDs may pose potential harm to the donor. Subject of Review: Living kidney donation is a safe procedure, but is associated with a small risk of end-stage kidney disease in the long- term. When elderly subjects and those with comorbidities are considered, long-term post-donation data are missing, making decisions regarding donation from these populations challenging. Further, vague guidelines have led to a wide heterogeneity in the criteria for living donation from marginal donors across centers and individuals. A recent survey by Lafranca et al. [PLoS One 2017;12:e0181846] collected information from 331 members (mainly physicians) of the European Society of Transplantation regarding several expanded LD criteria. Median refusal rate for potential expanded criteria (ECD) LDs is 15% and the authors found significant differences across regions in Europe in the acceptance of donors with ECD. Some transplant specialists did also deviate from their own transplant center policy, mainly to consider donors with high body mass index. Second Opinion: The survey by Lafranca et al. [PLoS One 2017;12:e0181846] documents extreme variability in the criteria for marginal LD selection. Many centers are deviating from the few agreed upon guideline criteria and are considering individuals with hypertension and minors for kidney donation. Intriguingly, one-fourth of the surgeons even deviate occasionally from center policy, especially when the issue is donor obesity. By and large, these data indicate that transplant community has a generally open approach toward extension of criteria for living donation, but long-term follow-up studies are needed to draw solid conclusions and guidelines.

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Quantifying Postdonation Risk of ESRD in Living Kidney Donors

Cited by 152 publications

References 17 publications

Risk of ESRD in prior living kidney donors

Risk of ESRD in prior living kidney donors

Causes and timing of end-stage renal disease after living kidney donation

Criteria for Living Donation from Marginal Donors: One, No One, and One Hundred Thousand

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