Risk of End-Stage Renal Disease Following Live Kidney Donation

Abstract

Importance-Risk of end-stage renal disease (ESRD) in kidney donors has been compared with risk faced by the general population, but the general population represents an unscreened, highrisk comparator. A comparison to similarly screened healthy nondonors would more properly estimate the sequelae of kidney donation.Objectives-To compare the risk of ESRD in kidney donors with that of a healthy cohort of nondonors who are at equally low risk of renal disease and free of contraindications to live donation and to stratify these comparisons by patient demographics.Copyright 2014 American Medical Association. All rights reserved.Corresponding Author: Dorry L. Segev, MD, PhD, Department of Transplant Surgery, Johns Hopkins Medical Institutions, 720 Rutland Ave, Ross 771B, Baltimore, MD 21205 (dorry@jhmi.edu). Author Contributions: Dr Muzaale had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis. Drs Muzaale and Massie contributed equally to this article. Disclaimer:The analyses described herein are the responsibility of the authors alone and do not necessarily reflect the views or policies of the US Department of Health and Human Services, nor does the mention of trade names, commercial products, or organizations imply endorsement by the US government. Conclusions and Relevance-Compared with matched healthy nondonors, kidney donors had an increased risk of ESRD over a median of 7.6 years; however, the magnitude of the absolute risk increase was small. These findings may help inform discussions with persons considering live kidney donation. HHS Public AccessEvery year in the United States, approximately 6000 healthy adults accept the risks of donor nephrectomy to help family members, friends, or even strangers improve survival and quality of life. 1 It is imperative that the transplant community, in due diligence to donors, understands the risk of donation to the fullest extent possible and communicates known risks to those considering donation. 2,3 To date, studies have shown that perioperative death is extremely rare and subsequent survival rates are comparable with healthy nondonors. [4][5][6] However, physiologic sequelae resulting from kidney donation remain less well characterized. Recent single-center 7-9 and nationwide 10 studies suggest that live donors do not have increased risk of end-stage renal disease (ESRD) compared with the general population; however, the general population is unscreened and, as such, at higher inherent risk of ESRD than carefully screened donors. Limited by small sample sizes and lack of a healthy comparison group, previous studies have been unable to compare the risk of ESRD that a healthy individual faces after donation with the risk that individual would have faced had he or she not donated. 11 Also, although studies show higher risk of ESRD in donor subgroups including black donors 10 compared with nonblack donors and male donors 8,9 compared with female donors, these studies comparing do...

Lifetime risk of renal replacement therapy in Europe: a population-based study using data from the ERA-EDTA Registry

“…The relative risk of RRT for ESRD is between 6 and 12 times higher in people who donated a kidney compared to equally healthy controls. [1,22] whether this elevated risk is acceptable depends on the absolute risk of RRT for the potential donor after donation. Together with information on a potential donor's risk factors and the relative risk induced by nephrectomy, country specific reference values for lifetime risk of RRT are needed to obtain this absolute risk of RRT after kidney donation.…”

“…However, those donating a kidney may themselves be at an increased risk of ESRD. [1] Therefore, we must ensure that those wishing to donate a kidney are adequately informed of their long-term risk of developing ESRD. Moreover, the new Kidney Disease Improving Global Outcomes (KDIGO) guidelines for the evaluation and follow-up care of living kidney donors are expected to move towards personalized, risk based screening of potential donors.…”

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“…Long-term safety of living kidney donation Two recent publications have raised questions about an increased (though small) risk of renal failure after kidney donation, and have generated much discussion (10,11). A number of abstracts presented at this meeting reported long-term follow up in living donors.…”

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“…Recently, Muzaale and colleagues reported a higher risk of devel oping ESRD among kidney donors than among healthy non-donors [28]. Previous studies had shown no significant effect of kidney donation on the risk of developing ESRD [29,30].…”