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Lifetime risks of kidney donation: a medical decision analysis
  1. Bryce A Kiberd,
  2. Karthik K Tennankore
  1. Department of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
  1. Correspondence to Dr Bryce A Kiberd; bryce.kiberd{at}nshealth.ca

Abstract

Objective This study estimated the potential loss of life and the lifetime cumulative risk of end-stage renal disease (ESRD) from live kidney donation.

Design Markov medical decision analysis.

Setting USA.

Participants 40-year-old live kidney donors of both sexes and black/white race.

Intervention Live donor nephrectomy.

Main outcome and measures Potential remaining life years lost, quality-adjusted life years (QALYs) lost and added lifetime cumulative risk of ESRD from donation.

Results Overall 0.532–0.884 remaining life years were lost from donating a kidney. This was equivalent to 1.20%–2.34% of remaining life years (or 0.76%–1.51% remaining QALYs). The risk was higher in male and black individuals. The study showed that 1%–5% of average-age current live kidney donors might develop ESRD as a result of nephrectomy. The added risk of ESRD resulted in a loss of only 0.126–0.344 remaining life years. Most of the loss of life was predicted to be associated with chronic kidney disease (CKD) not ESRD. Most events occurred 25 or more years after donation. Reducing the increased risk of death associated with CKD had a modest overall effect on the per cent loss of remaining life years (0.72%–1.9%) and QALYs (0.58%–1.33%). Smoking and obesity reduced life expectancy and increased overall lifetime risks of ESRD in non-donors. However the percentage loss of remaining life years from donation was not very different in those with or without these risk factors.

Conclusion Live kidney donation may reduce life expectancy by 0.5–1 year in most donors. The development of ESRD in donors may not be the only measure of risk as most of the predicted loss of life predates ESRD. The study identifies the potential importance of following donors and treating risk factors aggressively to prevent ESRD and to improve donor survival.

  • nephrectomy
  • live kidney donation
  • end stage renal disease
  • chronic kidney disease

This is an Open Access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/

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Footnotes

  • Contributors BAK is the guarantor of the study. BAK affirms that the manuscript is an honest, accurate and transparent account of the study. Both BK and KKT were involved with the study design, assigning data inputs, sensitivity analyses, writing and final approval of the paper.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement The data are incorporated in TreeAge software program. Those interested would need this program.

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