Renal function and cardiovascular outcomes after living donor nephrectomy in the UK: quality and safety revisited

Abstract

Objective To determine renal function and cardiovascular outcomes after living donor nephrectomy (LDN). Living donor kidney transplantation has become established as the treatment of choice for end‐stage renal failure. Benefits to the recipient have to be balanced against perioperative and long‐term health risks to the donor. Subjects/Patients and Methods The UK Transplant Registry (UKTR) was used to identify 4586 living donors who had donated a kidney for transplantation in the UK between 2001 and 2008. This study was conducted with the consent and support of the NHS Blood and Transplant (NHSBT) Kidney and Pancreas Research Group. Results The mean glomerular filtration rate (GFR) fell from 103 mL/min/1.73 m2 before LDN to 58 mL/min/1.73 m2 1 year after LDN. At 1 year after LDN 60% of donors had a GFR of <60 mL/min/1.73 m2. A GFR of <60 mL/min/1.73 m2 after LDN was associated with older age, females, lower GFR before LDN, White ethnicity, earlier LDN period, unrelated donor type and body mass index of >25 kg/m2. Over a 2‐year period after LDN there was an overall mortality rate of 0.39%, cardiovascular death in one patient (mortality rate of 0.02%) and a major cardiovascular event rate of 0.44%. Conclusion In this study we show that mild renal dysfunction is common after LDN; however, due to the short duration of follow‐up we are unable to comment on whether this subsequently leads to an increased risk of developing of cardiovascular disease.

Assessment of renal function in living kidney donors before and after nephrectomy: A Japanese prospective, observational cohort study

“…In the present study, 35.6% of kidney donors had a GFR of <60 mL/min/1.73 m 2 1 year after donor nephrectomy. Other groups have reported that 38–85% of patients had an eGFR of <60 mL/min/1.73 m 2 after donor nephrectomy . Lower mGFR and age were significant predictors of CKD in the present study.…”

“…Other groups have reported that 38-85% of patients had an eGFR of <60 mL/min/1.73 m 2 after donor nephrectomy. [19][20][21][22][23][24] Lower mGFR and age were significant predictors of CKD in the present study. Whether the reduction in GFR and incidence of mGFR <60 mL/min/1.73 m 2 post-nephrectomy have an impact on long-term outcomes in older donors is still debated and actually very unlikely.…”

Organ-Specific Monitoring of Solitary Kidney after Living Donation by Using Markers of Glomerular Filtration Rate and Urinary Proteins

“…One year after DN, renal function is reduced by approximately 30% of the preoperative value [28][29][30], which confirmed our results. At the end of the study period, more than a third of our living donors had a moderate to high risk of CKD progression, similar to reports by other authors [31][32][33]. However, Kishnan et al [34] demonstrated no higher risk of development of CKD stage 4/5 (eGFR <30 mL/min/1.73 m 3 ) in <10-year fol- low-up after comparison of live donor datasets from the UK Transplant Registry with the cohort of healthy nondonors from the Health Improvement Network database.…”

Long-term health-related quality of life of living kidney donors: a single-center experience

“…Although it is evident that there are some changes similar to mild chronic kidney disease after kidney donation [10][11][12], the risk of the procedure is considered low for donors [7][8][9]. Nevertheless, newer studies indicate that LKD might be at risk of metabolic disorders and renal failure, which could lead to an increase in mortality [44].…”

“…LKDT is considered a safe procedure for donors, and there seems to be no increased risk of deteriorated renal function or other relevant disabilities like hypertension or proteinuria [7][8][9]. Nevertheless, mild changes after kidney donation similar to chronic kidney disease have been reported [10][11][12]. There appears to be some risk of the development of end-stage renal disease (ESRD) in the long term [13].…”