Attitudes Among Surgeons Towards Live-Donor Nephrectomy

Klop, Karel; Dols, Leonienke F. C.; Kok, Niels F. M.; Weimar, Willem; IJzermans, Jan N.M.

doi:10.1097/tp.0b013e3182577501

Cited by 35 publications

(28 citation statements)

References 22 publications

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“…Many older recipients are reluctant to accept organs from younger donors; therefore, with the increase in older patients with end‐stage renal disease, a parallel increase in the number of older donors has been observed. Most guidelines do not state an upper age limit for kidney donors per se , but there is sometimes a reluctance to accept older donors as they are deemed at higher risk of postoperative complications. As well as presenting an unacceptable risk for the donor, this may also negatively impact a whole donor programme in the event of an operative death.…”

Section: Renal Transplantationmentioning

confidence: 99%

Kidney and liver transplantation in the elderly

Sutherland

IJzermans

Forsythe

et al. 2016

Journal of British Surgery

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Background: Transplant surgery is facing a shortage of deceased donor organs. In response, the criteria for organ donation have been extended, and an increasing number of organs from older donors are being used. For recipients, the benefits of transplantation are great, and the growing ageing population has led to increasing numbers of elderly patients being accepted for transplantation. Methods:The literature was reviewed to investigate the impact of age of donors and recipients in abdominal organ transplantation, and to highlight aspects of the fine balance in donor and recipient selection and screening, as well as allocation policies fair to young and old alike.Results: Overall, kidney and liver transplantation from older deceased donors have good outcomes, but are not as good as those from younger donors. Careful donor selection based on risk indices, and potentially biomarkers, special allocation schemes to match elderly donors with elderly recipients, and vigorous recipient selection, allows good outcomes with increasing age of both donors and recipients. The results of live kidney donation have been excellent for donor and recipient, and there is a trend towards inclusion of older donors. Future strategies, including personalized immunosuppression for older recipients as well as machine preservation and reconditioning of donor organs, are promising ways to improve the outcome of transplantation between older donors and older recipients.Conclusion: Kidney and liver transplantation in the elderly is a clinical reality. Outcomes are good, but can be optimized by using strategies that modify donor risk factors and recipient co-morbidities, and personalized approaches to organ allocation and immunosuppression.

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Section: Renal Transplantationmentioning

confidence: 99%

Kidney and liver transplantation in the elderly

Sutherland

IJzermans

Forsythe

et al. 2016

Journal of British Surgery

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“…In addition, health‐related QoL of donors after the procedure has proven to be better than that of the general population . Driven by its success, the inclusion criteria of the living donation programme gradually have been extended and older donors and donors with minor comorbidities such as hypertension and obesity have become eligible for donation .…”

Section: Introductionmentioning

confidence: 99%

Five-year follow-up after live donor nephrectomy - cross-sectional and longitudinal analysis of a prospective cohort within the era of extended donor eligibility criteria

et al. 2016

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To establish the outcome of live kidney donors 5 years after donation, we investigated the risk for progressive renal function decline and quality of life (QoL). Data on estimated glomerular filtration rate (eGFR), creatinine, hypertension, QoL and survival were assessed in a prospective cohort of 190 donors, who donated between 2008 and 2010. Data were available for >90%. The mean age predonation was 52.8 ± 11.5 years, 30 donors having pre-existent hypertension. The mean follow-up was 5.1 ± 0.9 years. Eight donors had died due to non-donation-related causes. After 5 years, the mean eGFR was 60.2 (95% CI 58.7-62.7) ml/min/1.73 m , with a median serum creatinine of 105.1 (95% CI 102.5-107.8) μmol/l. eGFR decreased to 33.6% and was longitudinally lower among men than women and declining with age (P < 0.001), without any association on QoL. Donors with pre-existent and new-onset hypertension demonstrated no progressive decline of renal function overtime compared to nonhypertensives. No donors were found with proteinuria, microalbuminuria or at risk for end-stage renal disease. After an initial decline postdonation, renal function remained unchanged overtime. Men and ageing seem to affect renal function overtime, while decreased renal function did not affect QoL. These data support further stimulation of living kidney donation programmes as seen from the perspective of donor safety.

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“…While the donor is not the patient, he or she is willingly exposed to harm of the surgical procedure to improve the well‐being of another individual. Laparoscopic donor nephrectomy has become the standard of care for live kidney donors . This approach has proven to limit discomfort, shorten length of hospital stay, and enable faster recovery with less fatigue and better quality of life (QOL) up to 1 year after donation .…”

Section: Introductionmentioning

confidence: 99%

More than a decade after live donor nephrectomy: a prospective cohort study

et al. 2015

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SummaryPreviously reported short-term results after live kidney donation show no negative consequences for the donor. The incidence of new-onset morbidity takes years to emerge, making it highly likely that this will be missed during short-term follow-up. Therefore, evidence on long-term outcome is essential. A 10-year follow-up on renal function, hypertension, quality of life (QOL), fatigue, and survival was performed of a prospective cohort of 100 donors. After a median follow-up time of 10 years, clinical data were available for 97 donors and QOL data for 74 donors. Nine donors died during follow-up of unrelated causes to donation, and one donor was lost to follow-up. There was a significant decrease in kidney function of 12.9 ml/min (P < 0.001) at follow-up. QOL showed significant clinically relevant decreases of 10-year follow-up scores in SF-36 dimensions of physical function (P < 0.001), bodily pain (P = 0.001), and general health (P < 0.001). MFI-20 scores were significantly higher for general fatigue (P < 0.001), physical fatigue (P < 0.001), reduced activity (P = 0.019), and reduced motivation (P = 0.030). New-onset hypertension was present in 25.6% of the donors. Donor outcomes are excellent 10 years post-donation. Kidney function appears stable, and hypertension does not seem to occur more frequently compared to the general population.

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Attitudes Among Surgeons Towards Live-Donor Nephrectomy

Cited by 35 publications

References 22 publications

Kidney and liver transplantation in the elderly

Kidney and liver transplantation in the elderly

Five-year follow-up after live donor nephrectomy - cross-sectional and longitudinal analysis of a prospective cohort within the era of extended donor eligibility criteria

More than a decade after live donor nephrectomy: a prospective cohort study

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