Racial Variation in Medical Outcomes among Living Kidney Donors

Lentine, Krista L.; Schnitzler, Mark A.; Xiao, Huiling; Saab, Georges; Salvalaggio, Paolo R.; Axelrod, David A.; Davis, Connie L.; Abbott, Kevin C.; Brennan, Daniel C.

doi:10.1056/nejmoa1000950

Cited by 273 publications

(281 citation statements)

References 31 publications

Supporting

Mentioning

264

Contrasting

Unclassified

Order By: Relevance

“…Differences in short-and long-term outcomes among these groups relative to those in whites have been documented in other studies and merit continued surveillance (5,6). The primary diagnoses at rehospitalization were not markedly different by race/ethnicity except for higher rates for pregnancy-related hospitalizations among Hispanics and higher rates of hospitalizations for mental disorders among whites.…”

Section: Discussionmentioning

confidence: 52%

“…Mortality rates are not elevated among living donors compared with the general population, even after exclusion of individuals with documented contraindications to donation; however, African Americans, Hispanics, men, and donors with hypertension have relatively increased perioperative mortality (5). Among living donors with private health insurance, African Americans and Hispanics have an increased risk of hypertension and diabetes and an incidence of ESRD of 0.13% at a median 7.7 years of follow-up after donation (6). The rate of selected comorbid conditions, including cancers, cardiovascular disease, depression, and fractures, following living donation is also generally similar to that among individuals characterized as the "healthiest" portion of the general population and among age-and sex-matched controls with commercial insurance (7)(8)(9)(10).…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Hospitalizations Following Living Donor Nephrectomy in the United States

Schold

Goldfarb

Buccini

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryBackground and objectives Living donors represented 43% of United States kidney donors in 2012. Although research suggests minimal long-term consequences of donation, few comprehensive longitudinal studies for this population have been performed. The primary aims of this study were to examine the incidence, risk factors, and causes of rehospitalization following donation.Design, setting, participants, & measurements State Inpatient Databases (SID) compiled by the Agency for Healthcare Research and Quality were used to identify living donors in four different states between 2005 and 2010 (n=4524). Multivariable survival models were used to examine risks for rehospitalization, and patient characteristics were compared with data from the Scientific Registry of Transplant Recipients (SRTR). Outcomes among patients undergoing appendectomy (n=200,274), cholecystectomy (n=255,231), and nephrectomy for nonmetastatic carcinoma (n=1314) were contrasted.Results The study population was similar to United States donors (for SRTR and SID, respectively: mean age, 41 and 41 years; African Americans, 12% and 10%; women, 60% and 61%). The 3-year incidence of rehospitalization following donation was 11% for all causes and 9% excluding pregnancy-related hospitalizations. After censoring of models for pregnancy-related rehospitalizations, older age (adjusted hazard ratio [AHR], 1.02 per year; 95% confidence interval [95% CI], 1.01 to 1.03), African American race (AHR, 2.16; 95% CI, 1.54 to 3.03), depression (AHR, 1.88; 95% CI, 1.12 to 3.14), hypothyroidism (AHR, 1.63; 95% CI, 1.06 to 2.49), and longer initial length of stay were related to higher rehospitalization rates among donors. Compared with living donors, adjusted risks for rehospitalizations were greater among patients undergoing appendectomy (AHR, 1.58; 95% CI, 1.42 to 1.75), cholecystectomy (AHR, 2.25; 95% CI, 2.03 to 2.50), and nephrectomy for nonmetastatic carcinoma (AHR, 2.95; 95% CI, 2.58 to 3.37). Risks for rehospitalizations were higher among African Americans than whites in each of the surgical groups.Conclusions The SID is a valuable source for evaluating characteristics and outcomes of living kidney donors that are not available in traditional transplant databases. Rehospitalizations following donor nephrectomy are less than seen with other comparable surgical procedures but are relatively higher among donors who are older, are African American, and have select comorbid conditions. The increased risks for rehospitalizations among African Americans are not unique to living donation.

show abstract

Section: Discussionmentioning

confidence: 52%

Section: Introductionmentioning

confidence: 99%

Hospitalizations Following Living Donor Nephrectomy in the United States

Schold

Goldfarb

Buccini

et al. 2014

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

show abstract

“…In the current study, male sex, baseline hypertension, and African American race were independently associated with perioperative complications in multivariable models. These same characteristics have also been associated with increased risk of later medical complications, ESRD, and death within other donor cohorts (10)(11)(12). Whether early complications play a mediating role in the long-term risks needs to be defined in data sources (or primary studies) capturing longitudinal outcomes.…”

mentioning

confidence: 99%

Better Understanding Live Donor Risk through Big Data

Lentine

Segev

2013

Clinical Journal of the American Society of Nephrology

Self Cite

View full text Add to dashboard Cite

In the context of the organ shortage, kidney transplantation from living donors has increased markedly over the last several decades. This growth in living donation has been accompanied by changes in donor characteristics, including greater racial and ethnic diversity and more unrelated donors (1). Recent studies also suggest an increase in donation from persons with baseline medical complexity, including obesity, hypertension, glucose intolerance, and even reduced renal function (2,3). However, capture of early complications by the national transplant registry has suffered from frequent missing data and under-reporting. Early postoperative complications reported by transplant centers to the Organ Procurement and Transplantation Network (OPTN) on the living donor registration form (submitted at discharge or within 6 weeks of the donation hospitalization) in 2000-2012 indicated the need for blood transfusion in 0.4%, vascular complications in 0.3%, readmission in 2.1%, reoperation in 0.5%, and other interventions in 0.8% (4). These center-reported frequencies are markedly lower than estimates of 3%-6% for major complications and 18%-22% for minor complications based on application of the Clavien classification system to sources such as a prospective Norwegian donor registry and United States hospital coding data (5).On the background of uncertainty regarding the true distribution of perioperative complications after donor nephrectomy, a new article by Schold et al. illustrates an innovative approach (6). Using data from the Nationwide Inpatient Sample (NIS), an all-payer inpatient care database comprising a stratified sample of 20% of nonfederal United States hospitals from participating states, the investigators identified living kidney donors in 1998-2010 on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes. Baseline comorbidity and complications during the hospitalization of the nephrectomy procedure (and thus presumably related to it, although timing of the various codes is not specified in NIS) were ascertained by diagnosis codes, and the frequency of complications was compared with that among patients who underwent appendectomy, cholecystectomy, and nephrectomy for nonmetastatic cancer. The authors reported a sample equivalent of 69,117 donors. Of note, in studies of NIS the actual number of patients from whom inferences are drawn is usually about one tenth the size of the sample equivalent size. In other words, one would estimate that approximately 7000 actual donors were identified and studied (similar to subject counts of 6300-9400 in recent studies identifying donor nephrectomies from the NIS directly in comparable time periods without the use of weighting [7,8]), but these represented about 70,000 donors nationally because of the sampling scheme used by NIS (and the weighted sample is more representative of the national population than an unweighted sample).Among donors identified in NIS, the proportion of documented baseline como...

show abstract

“…A large-scale analysis of the development of diabetes in living donors did not show any difference between donors and the expected control rate but was based on a population of mostly white donors from Minnesota and may not be generalizable to high-risk minority donors (30). A recent review of follow-up data from black and Hispanic donors in the United States revealed not only an increased risk for drug-treated diabetes after donation but also a higher risk for hypertension and CKD compared with white donors (10). Similarly, assessment of indigenous (Aboriginal) living donors in Canada, followed for a mean of 14 years, demonstrated higher rates of hypertension and diabetes compared with white donors (31).…”

Section: Ethnicitymentioning

confidence: 92%

“…Are we putting kidney donors with glucose intolerance at more risk for cardiovascular complications because both IFG and reductions in GFR (8,9) are risk factors for cardiovascular disease (CVD)? With the frequency of hypertension and diabetes being higher in African-American, Hispanic, and Native American donors (10), should acceptability of donors with IFG be influenced by ethnicity? Should decisions regarding these issues be influenced by donor age?…”

Section: Introductionmentioning

confidence: 99%

Should Living Kidney Donor Candidates with Impaired Fasting Glucose Donate?

Vigneault

Asch

Bia

2011

Clinical Journal of the American Society of Nephrology

View full text Add to dashboard Cite

SummaryAs the kidney transplant waiting list grows, the willingness of transplant centers to accept complex donors increases. Guidelines for the evaluation of living kidney donors exist but do not provide clear guidance when evaluating the complex donor. Although few transplant centers will approve donor candidates with impaired glucose tolerance and most, if not all, will deny candidates with diabetes, many will approve candidates with impaired fasting glucose (IFG). Furthermore, the demographic of living donors has changed in the past 10 years to increasingly include more nonwhite and Hispanic individuals who are at greater risk for future diabetes and hypertension. IFG may be more of a concern in potential donors whose nonwhite and Hispanic ethnicity already places them at greater risk. We review the definition of diabetes, diabetes prediction tools, and transplant guidelines for donor screening and exclusion as it pertains to impaired glucose metabolism, and additional ethnic and nonethnic factors to consider. We offer an algorithm to aid in evaluation of potential living donors with IFG in which ethnicity, age, and features of the metabolic syndrome play a role in the decision making.

show abstract

Racial Variation in Medical Outcomes among Living Kidney Donors

Cited by 273 publications

References 31 publications

Hospitalizations Following Living Donor Nephrectomy in the United States

Hospitalizations Following Living Donor Nephrectomy in the United States

Better Understanding Live Donor Risk through Big Data

Should Living Kidney Donor Candidates with Impaired Fasting Glucose Donate?

Contact Info

Product

Resources

About