Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors

Massie, Allan B.; Holscher, Courtenay M.; Henderson, Macey L.; Fahmy, Lara M.; Thomas, Alvin G.; Ammary, Fawaz Al; Getsin, Samantha; Snyder, Jon J.; Lentine, Krista L.; Garg, Amit X.; Segev, Dorry L.

doi:10.1001/jamasurg.2019.5472

Cited by 39 publications

(44 citation statements)

References 34 publications

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“…We acknowledge that change in eGFR remains an outcome that does not directly impact how a person feels or functions, and in another study, every 10 ml/min per 1.73 m 2 reduction in eGFR 6 months after donation was associated with a 28% higher risk of kidney failure after adjusting for other baseline factors. 27 Despite a lower postdonation increase in eGFR in females in our study, in predictive risk models, the projected incidence of kidney failure in female donors is lower than that in male donors. 28 There is conflicting evidence to support explanations for this paradoxical finding, including lifestyle and biological factors that may influence GFR decline, along with nonbiological factors, such as use of preventative healthcare, that may influence renal replacement therapy initiation.…”

Section: Discussioncontrasting

confidence: 59%

Changes in kidney function follow living donor nephrectomy

Lam

Lloyd

Lentine

et al. 2020

Kidney International

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Better understanding of kidney function after living donor nephrectomy and how it differs by donor characteristics can inform patient selection, counselling, and follow-up care. To evaluate this, we conducted a retrospective matched cohort study of living kidney donors in Alberta, Canada between 2002-2016, using linked healthcare administrative databases. We matched 604 donors to 2,414 healthy non-donors from the general population based on age, sex, year of cohort entry, urban residence and the estimated glomerular filtration rate (eGFR) before cohort entry (nephrectomy date for donors and randomly assigned date for non-donors). The primary outcome was the rate of eGFR change over time (median follow-up seven years; maximum 15 years). The median age of the cohort was 43 years, 64% women, and the baseline (pre-donation) eGFR was 100 mL/min/1.73 m 2. Overall, from six weeks onwards, the eGFR increased by D0.35 mL/min/1.73 m 2 per year (95% confidence interval D0.21 to D0.48) in donors and significantly decreased by-0.85 mL/min/1.73 m 2 per year (-0.94 to-0.75) in the matched healthy non-donors. The change in eGFR between six weeks to two years, two to five years, and over five years among donors was D1.06, D0.64, and-0.06 mL/min/1.73 m 2 per year, respectively. In contrast to the steady age-related decline in kidney function in non-donors, post-donation kidney function on average initially increased by 1 mL/min/1.73 m 2 per year attributable to glomerular hyperfiltration, which began to plateau by five years post-donation. Thus, the average change in eGFR over time is significantly different between donors and non-donors.

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Section: Discussioncontrasting

confidence: 59%

Changes in kidney function follow living donor nephrectomy

Lam

Lloyd

Lentine

et al. 2020

Kidney International

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“… 6 Although most programs reported continuing some form of post-donation follow-up, a minority deferred laboratory follow-up. Although early postdonation complications rates are very low in general, recent data demonstrate the prognostic importance of early post-donation renal function, 22 and thus overcoming pandemic-related, patient level and system-level barriers to donor follow-up is an important priority. Widespread telehealth should be beneficial in donor evaluation and postdonation follow-up practices, even after the pandemic, as it provides the donor with flexibility and minimizes inconveniences while maintaining safety and contact with the program.…”

Section: Discussionmentioning

confidence: 99%

Survey of US Living Kidney Donation and Transplantation Practices in the COVID-19 Era

Lentine

Vest

Schnitzler

et al. 2020

Kidney International Reports

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Introduction: The scope of the impact of the COVID-19 pandemic on living donor kidney transplantation (LDKT) practices is not well defined. Methods: We surveyed US transplant programs to assess practices, strategies, and barriers to living LDKT during the COVID-19 pandemic. After institutional review board approval, the survey was distributed from 9 May 2020 to 30 May 2020 by e-mail and postings to professional society list-servs. Responses were stratified based on state COVID-19 cumulative incidence levels. Results: Staff at 118 unique centers responded, representing 61% of US living donor recovery programs and 75% of LKDT volume in the prepandemic year. Overall, 66% reported that LDKT surgery was on hold (81% in "high" vs. 49% in "low" COVID-19 cumulative incidence states). A total of 36% reported that evaluation of new donor candidates had paused, 27% reported that evaluations were very much decreased (>0% to <25% typical), and 23% reported that evaluations were moderately decreased (25% to <50% typical). Barriers to LDKT surgery included program concerns for donor (85%) and recipient (75%) safety, patient concerns (56%), elective case restrictions (47%), and hospital administrative restrictions (48%). Programs with higher local COVID-19 cumulative incidence reported more barriers related to staff and resource diversion. Most centers continuing donor evaluations used remote strategies (video, 82%; telephone, 43%). As LDKT resumes, all programs will screen for COVID-19, although timeframe and modalities will vary. Recommendations for presurgical self-quarantine are also variable. Conclusion: The COVID-19 pandemic has had broad impacts on LDKT practice. Ongoing research and consensus building are needed to reduce barriers, to guide optimal practices, and to support safe restoration of LDKT across centers.

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“…Transplant centers have been challenged during the pandemic to conduct appropriate patient follow‐up. It is paramount that donors and recipients are assured that their safety is important to every transplant program, especially during the early postdonation period when assessment of renal function is critical 27 . Outside of North American and Europe, programs that continued follow‐up relied largely on in‐person visits.…”

Section: Discussionmentioning

confidence: 99%

An International survey on living kidney donation and transplant practices during the COVID‐19 pandemic

Salvalaggio

Ferreira

Çalışkan

et al. 2020

Transplant Infectious Dis

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The scope of the impact of the Coronaviru s disease 19 (COVID‐19) pandemic on living donor kidney transplantation (LDKT) practices across the world is not well defined. We received survey responses from 204 transplant centers internationally from May to June 2020 regarding the impact of the COVID‐19 pandemic on LDKT practices. Respondents represented 16 countries on 5 continents. Overall, 75% of responding centers reported that LDKT surgery was on hold (from 67% of North American centers to 91% of European centers). The majority (59%) of centers reported that new donor evaluations were stopped (from 46% of North American centers to 86% of European centers), with additional 23% of centers reporting important decrease in evaluations. Only 10% of centers reported slight variations on their evaluations. For the centers that continued donor evaluations, 40% performed in‐person visits, 68% by video, and 42% by telephone. Center concerns for donor (82%) and recipient (76%) safety were the leading barriers to LDKT during the pandemic, followed by patients concerns (48%), and government restrictions (46%). European centers reported more barriers related to staff limitations while North and Latin American centers were more concerned with testing capacity and insufficient resources including protective equipment. As LDKT resumes, 96% of the programs intend to screen donor and recipient pairs for coronavirus infection, most of them with polymerase chain reaction testing of nasopharyngeal swab samples. The COVID‐19 pandemic has had broad impact on all aspects of LDKT practice. Ongoing research and consensus‐building are needed to guide safe reopening of LDKT programs.

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Association of Early Postdonation Renal Function With Subsequent Risk of End-Stage Renal Disease in Living Kidney Donors

Cited by 39 publications

References 34 publications

Changes in kidney function follow living donor nephrectomy

Changes in kidney function follow living donor nephrectomy

Survey of US Living Kidney Donation and Transplantation Practices in the COVID-19 Era

An International survey on living kidney donation and transplant practices during the COVID‐19 pandemic

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