Is Living Kidney Donation Really Safe?

doi:10.1016/j.transproceed.2007.04.017

Transplantation Proceedings

Volume 39, Issue 4, May 2007, Pages 822-823

https://doi.org/10.1016/j.transproceed.2007.04.017 Get rights and content

Abstract

Objective

Living donor kidney transplantation (LDKT) yields the best results of all renal replacement therapies in terms of patient and graft survival. It is the main method in many countries because of worsening patient outcomes due to the accumulation of aged patients with long periods on dialysis and no possibility to increase the number of cadaver donor transplantations. Because of concerns dealing the risks inflicted on the donors, we sought to evaluate the long-term complications of LDKT.

Patients and Methods

We evaluated over 3 years 86 living kidney donors (58 men, 28 women) whose procedures were >1 year ago. The mean time postoperatively was 17.24 ± 5.04 months and their mean age, 28.97 ± 4.75 years. Basic information regarding current health status, including physical examination and blood pressure as well as serum urea, creatinine serum albumin, blood glucose, lipid profile, urinanalysis, and 24-hour urine protein were evaluated every 6 months after donation. Also an ultrasound of the kidney, urinary tract, and testis was performed at these times.

Results

Donor nephrectomies were left sided in 60 (69.8%) cases and right sided in 26 (30.2%) cases. The majority of the donors (n = 80) were unrelated (93%). There was a total complication rate of 54.6%. The most common complication was hypertension (37.5%). Serious complications occurred in five cases (5.8%). In six (6.9%) the patients serum creatinine was ≥1.4 mg/dL. Microalbuminuria was found in 10.4%; hematuria in 13.9%; pyuria in 8.1%; and renal stone in 6.9%. Varicocele was found in 24.1% of male patients (23.3% of patients who had left nephrectomised). Persistent pain was reported by 44.1%. Antidepressants were prescribed to 9.3% of donors because of severe depression.

Conclusion

Living kidney donation is not so safe and has some late complications. Precise predonation evaluation and long-term follow-up of kidney donors for detection and prevention of complications is necessary.

Section snippets

Patients and Methods

We evaluated 86 living kidney donors (58 men, 28 women) from October 2002 to October 2005, whose donation was >1 year prior (mean, 17.24 ± 5.04). We evaluated basic information regarding current health status including physical examination and blood pressure, serum urea, creatinine and albumin, blood glucose, lipid profile, urinanalysis and 24-hour urine protein every 6 months after kidney donation. Ultrasounds of the kidney, urinary tract and testis were also performed in these periods.

Results

Mean age at the time of donation was 28.97 ± 4.75 years (range, 18 to 47 years), including 32.5% women. Donor nephrectomies were left sided in 60 (69.8%) cases and right sided in 26 (30.2%) cases. The majority of donors (n = 80) were unrelated (93%). No patient died. There was a total complication rate of 54.6%. The most common noticeable complication was hypertension, which occurred in 32/86 patients (37.5%), namely 21 males and 11 females. This complication was moderate (mean, 160/98) in 3

Discussion

The potential risks of living kidney donation are still controversial. Although other authors have reported a small decrease in glomerular filtration rate immediately after transplantation but with no further decline, the risk of end-stage renal failure in living donors is approximately 0.2% to 0.5%. Although other authors have reported only a few patients that developed proteinuria and, after age adjustment, no increased blood pressure,⁵ we observed a high rate of hypertension and proteinuria

References (5)

G. Petranyi et al.
Advantages of living donor kidney transplantation; possibilities in the national transplantation program
Orv Hetil
(2004)
M. Siebels et al.
Risks and complications in 160 living kidney donors who underwent nephroureterectomy
Nephrol Dial Transplant
(2003)

There are more references available in the full text version of this article.

Cited by (26)

Comparison of health status and quality of life of related versus paid unrelated living kidney donors
2013, American Journal of Transplantation
The aim of this cross-sectional study was to assess the health status and quality of life (QOL) of paid unrelated versus related living kidney donors postdonation at Shiraz Transplant Center in Iran. We invited all donors (n = 580, 347 paid unrelated, 233 related) who underwent donor nephrectomy at our center from 2004 to 2010 to participate in a health survey and physical examination. Of 580 donors, 144 consented to participate; participation of paid unrelated donors was significantly lower than related (52/347 vs. 92/233; p < 0.001). Participants underwent a complete physical examination, QOL assessment (using a 36-item short form health survey [SF-36] questionnaire) and laboratory work-up. The paid unrelated donors compared with related donors were younger (34.2 ± 7.2 vs. 40.7 ± 9.7 years, p < 0.001), had shorter time since donation (2.9 ± 1.6 vs. 3.8 ± 2 years, p = 0.004), had higher estimated GFR (72.6 ± 22 vs. 63.8 ± 15.3 mL/min/1.73 m², p = 0.006) and had a higher percentage of patients with microalbuminuria (35% vs. 0%, p < 0.001). Additionally, general health and social functioning scores among paid unrelated donors were significantly lower (p < 0.001 and p = 0.02, respectively) than related donors. Other SF-36 scores, although lower in paid unrelated donors, did not reach statistical significance. Iranian paid unrelated donors have lower QOL and higher incidence of microalbuminuria compared with related donors.
The Iranian model of living renal transplantation
2012, Kidney International
Citation Excerpt :
In the Ibrahim et al.17 study, 12.2±9.2 years after donation the prevalence of hypertension and microalbuminuria were 32.1% and 12.7%, respectively. They have been 37.5% and 10.4%, respectively, in the only short-term medical follow-up (17.2±5.0 months) in the Iranian donors.19 Lack of long-term donor follow-up in Iranian model is one of the major weak points of the system.
Organ shortage for transplantation remains a worldwide serious problem for kidney patients with end-stage renal failure, and several countries have tried different models to address this issue. Iran has 20 years of experience with one such model that involves the active role of the government and charity foundations. Patients with a desperate demand for a kidney have given rise to a black market of brokers and other forms of organ commercialism only accessible to those with sufficient financial resources. The current Iranian model has enabled most of the Iranian kidney transplant candidates, irrespective of socioeconomic class, to have access to kidney transplantation. The Iranian government has committed a large budget through funding hospital and staff at the Ministry of Health and Medical Education by supporting the brain death donation (BDD) program or redirecting part of the budget of living unrelated renal donation (LURD) to the BDD program. It has been shown that it did not prevent the development and progression of a BDD program. However, the LURD program is characterized by several controversial procedures (e.g., confrontation of donor and recipient at the end of the evaluation procedure along with some financial interactions) that should be ethically reviewed. Operational weaknesses such as the lack of a registration system and long-term follow-up of the donors are identified as the ‘Achilles heel of the model’.
The assessment of long-term clinic and laboratory data of living related kidney donors
2012, Transplantation Proceedings
Living-donor kidney transplantations are more common in Turkey. The present study, therefore, investigated the structural changes in the remaining kidney and their impacts on the outcomes of 71 donors who underwent nephrectomy. Among 123 screened living-donor transplantations performed between 2001 and 2008, information was available on 71. The study group included 37 female and 34 male donors with ages ranging between 20 and 68 years (mean, 45 ± 9 years). The donors had a median follow-up of 7.2 years. We investigated renal function and creatinine clearance as well as the presence of proteinuria and/or hypertension before versus after nephrectomy. Healthy individuals referred to our blood center were included as the control group. A comparison of pre- versus post-nephrectomy with control group data did not show any significant correlations between serum creatinine levels, creatinine clearances, and the presence of proteinuria relative to post-donation years. In contrast, we identified an increased prevalence of hypertension: Stage 1 in 4 patients before versus 22 subjects after nephrectomy. A key finding of this study was the slight increase in the number of hypertensive donors. Hypertension is, therefore, the most critical parameter to monitor donors in countries with a high proportion of living donors.
Long-term risk of hypertension and chronic kidney disease in living kidney donors
2012, Transplantation Proceedings
Citation Excerpt :
In the present study, a slight increase in proteinuria, which was not statistically significant, was observed after nephrectomy, and only 3% of donors developed overt proteinuria. Recent studies have shown that proteinuria increases from 1.8% to 41% after KT.9 However, negligible proteinuria of unknown clinical significance was reported with no long-term adverse effects during renal disease progression.8
The aim of this study was to assess the long-term risks of chronic kidney disease and arterial hypertension in living kidney donors.
Donors who were followed for more than 1 year after nephrectomy were included. We assessed each donor's blood pressure, urine protein, and estimated glomerular filtration rate (eGFR).
The follow-up rate was 11% (154 out of 1,356 donors), only 19% of whom were followed by nephrologists. Blood pressure had increased from 113/75 to 116/77 mm Hg (P < .01), urinary protein excretion after donation did not increase, and renal function was well preserved after donor nephrectomy. However, 33 patients (21.4%) showed a decreased eGFR of <60 mL/min/1.73 m², and 3 donors developed end-stage renal disease that required renal replacement therapy.
The follow-up rate of living donors after donation was low, and we observed an increased risk of developing chronic kidney disease after donation.
Risk Factors for Deterioration of Renal Function After Donor Nephrectomy
2010, Transplantation Proceedings
Citation Excerpt :
Long-term follow-up studies of living donors have shown the prevalence of hypertension to be similar to the age-matched general population.7–9 However, blood pressure tends to increase after kidney donation.10–12 A Swiss survey reported untreated hypertension among the living donor group caused a higher risk for development of glomerulosclerosis than among people with 2 kidneys.13
There are few recent studies investigating increased risks for adverse effects leading to chronic kidney disease (CKD) among kidney donors. The aim of this study was to identify factors that protect renal function among actual live kidney donors.
We enrolled 68 individuals who had undergone donor nephrectomy in this study. We assessed donor age, body mass index (BMI), casual blood pressure, preoperative and 3-month follow-up serum creatinines, serum total cholesterol, and several other clinical parameters. The severity of arteriosclerosis in the arteriolar and interlobular arteries of the donor kidney was semiquantitatively evaluated in 4 grades using back table biopsies. Impairment of renal function after surgery was expressed by differences in serum creatinine levels.
The ratio of glomerular sclerosis, systolic blood pressure, and diastolic blood pressure positively correlated with donor age. Deterioration of renal function after donor nephrectomy negatively correlated with BMI and positively correlated with severity of arteriosclerosis in interlobular arteries. A multiple regression analysis model with respect to the severity of arteriosclerosis in interlobular arteries showed significant influence, of serum creatinine and systolic blood pressure.
Preventing progression of arteriosclerosis and selecting the optimal BMI before donor nephrectomy will help to avoid impaired renal function among live kidney donors.
The Assessment of Residual Kidney Function After Living Donor Nephrectomy
2009, Transplantation Proceedings
Citation Excerpt :
Microalbuminuria was observed in 10.4% of kidney donors.15 Hypertension occurred in 27%–32% of the donors.11,14 The long-term incidence of hypertension in living donors was comparable to that expected in the age-matched general population.8,15
The number of patients on the waiting list for kidney transplantation is increasing as a result of the cadaveric donor shortage. One way to expand the pool is living donor transplantation. However, only 2% of kidney transplants in Poland come from living-related donors.
We sought to assess residual renal function, incidence of hypertension, and proteinuria among living kidney donors.
Between 2004 and 2007, we performed 46 living donor open nephrectomies. The mean age of the kidney donor was 39 years (range, 25–57). The donors were predominantly females (61%). Mean hospitalization time was 8 days (range, 4–22). Nine donors did not report for follow-up visits. The observation periods ranged from 1 to 24 months. Physical examination, blood and urine tests, as well as ultrasound scans were performed before nephrectomy and at every follow-up visit (1, 3, 12, and 24 months post operatively).
Mean creatinine concentration was higher at 3 months after nephrectomy than preoperatively (P < .05). Mean creatinine clearance according to Cockroft–Gault formula and mean creatinine clearance according to abbreviated modification of diet in renal disease equation (aMDRD) decreased after donation by 30% (P < .05). No cases of proteinuria were observed. Hypertension occurred in 1 donor (2.7%).
Living kidney donation resulted in a reduced creatinine clearance in the donor. Follow-up of living kidney donors is essential to determine risk factors for deterioration of residual kidney function.

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View full text

Organ donationLiving donor: Kidney donorIs Living Kidney Donation Really Safe?

Abstract

Objective

Patients and Methods

Results

Conclusion

Section snippets

Patients and Methods

Results

Discussion

Advantages of living donor kidney transplantation; possibilities in the national transplantation program

Orv Hetil

Risks and complications in 160 living kidney donors who underwent nephroureterectomy

Nephrol Dial Transplant

Organ donation
Living donor: Kidney donor
Is Living Kidney Donation Really Safe?