Comorbidity Burden and Perioperative Complications for Living Kidney Donors in the United States

Schold, Jesse D.; Goldfarb, David A.; Buccini, Laura D.; Rodrigue, James R.; Mandelbrot, Didier A.; Heaphy, Emily Lenore Goldman; Fatica, Richard; Poggio, Emilio D.

doi:10.2215/cjn.12311212

Cited by 97 publications

(54 citation statements)

References 34 publications

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“…Despite relatively reassuring data regarding the long-term health of donors, follow-up care is essential to monitor progress, identify morbidity, and facilitate any potential need for interventions (1)(2)(3)(4)(5)(6). In addition, there has been an increased rate of living donors with complex medical conditions, rendering vigilant monitoring for any potential health consequences of donation increasingly important (7)(8)(9)(10). Prior reports have indicated a lack of complete reporting of kidney donor follow-up on standard United Network for Organ Sharing (UNOS) forms (11)(12)(13).…”

Section: Introductionmentioning

confidence: 99%

Critical Factors Associated With Missing Follow-Up Data for Living Kidney Donors in the United States

Schold

Buccini

Rodrigue

et al. 2015

American Journal of Transplantation

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Follow-up care for living kidney donors is an important responsibility of the transplant community. Prior reports indicate incomplete donor follow-up information, which may reflect both donor and transplant center factors. New UNOS regulations require reporting of donor follow-up information by centers for 2 years. We utilized national SRTR data to evaluate donor and center-level factors associated with completed follow-up for donors 2008-2012 (n ¼ 30 026) using multivariable hierarchical logistic models. We compared center follow-up compliance based on current UNOS standards using adjusted and unadjusted models. Complete follow-up at 6, 12, and 24 months was 67%, 60%, and 50% for clinical and 51%, 40%, and 30% for laboratory data, respectively, but have improved over time. Donor risk factors for missing laboratory data included younger age 18-34

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Section: Introductionmentioning

confidence: 99%

Critical Factors Associated With Missing Follow-Up Data for Living Kidney Donors in the United States

Schold

Buccini

Rodrigue

et al. 2015

American Journal of Transplantation

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“…On the background of uncertainty regarding the true distribution of perioperative complications after donor nephrectomy, a new article by Schold et al illustrates an innovative approach (6). Using data from the Nationwide Inpatient Sample (NIS), an all-payer inpatient care database comprising a stratified sample of 20% of nonfederal United States hospitals from participating states, the investigators identified living kidney donors in 1998-2010 on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes.…”

mentioning

confidence: 99%

Better Understanding Live Donor Risk through Big Data

Lentine

Segev

2013

Clinical Journal of the American Society of Nephrology

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In the context of the organ shortage, kidney transplantation from living donors has increased markedly over the last several decades. This growth in living donation has been accompanied by changes in donor characteristics, including greater racial and ethnic diversity and more unrelated donors (1). Recent studies also suggest an increase in donation from persons with baseline medical complexity, including obesity, hypertension, glucose intolerance, and even reduced renal function (2,3). However, capture of early complications by the national transplant registry has suffered from frequent missing data and under-reporting. Early postoperative complications reported by transplant centers to the Organ Procurement and Transplantation Network (OPTN) on the living donor registration form (submitted at discharge or within 6 weeks of the donation hospitalization) in 2000-2012 indicated the need for blood transfusion in 0.4%, vascular complications in 0.3%, readmission in 2.1%, reoperation in 0.5%, and other interventions in 0.8% (4). These center-reported frequencies are markedly lower than estimates of 3%-6% for major complications and 18%-22% for minor complications based on application of the Clavien classification system to sources such as a prospective Norwegian donor registry and United States hospital coding data (5).On the background of uncertainty regarding the true distribution of perioperative complications after donor nephrectomy, a new article by Schold et al. illustrates an innovative approach (6). Using data from the Nationwide Inpatient Sample (NIS), an all-payer inpatient care database comprising a stratified sample of 20% of nonfederal United States hospitals from participating states, the investigators identified living kidney donors in 1998-2010 on the basis of International Classification of Diseases, Ninth Revision, Clinical Modification diagnosis and procedure codes. Baseline comorbidity and complications during the hospitalization of the nephrectomy procedure (and thus presumably related to it, although timing of the various codes is not specified in NIS) were ascertained by diagnosis codes, and the frequency of complications was compared with that among patients who underwent appendectomy, cholecystectomy, and nephrectomy for nonmetastatic cancer. The authors reported a sample equivalent of 69,117 donors. Of note, in studies of NIS the actual number of patients from whom inferences are drawn is usually about one tenth the size of the sample equivalent size. In other words, one would estimate that approximately 7000 actual donors were identified and studied (similar to subject counts of 6300-9400 in recent studies identifying donor nephrectomies from the NIS directly in comparable time periods without the use of weighting [7,8]), but these represented about 70,000 donors nationally because of the sampling scheme used by NIS (and the weighted sample is more representative of the national population than an unweighted sample).Among donors identified in NIS, the proportion of documented baseline como...

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“…With the evolution in surgical techniques for donor nephrectomy [24], perioperative outcomes are excellent [6, 20, 25–29] and continue to improve, despite increasing donor comorbidity [29]. Survival from nephrectomy is outstanding, with a perioperative death rate of 0.03 % [6, 25].…”

Section: Overall Outcomes Of Living Donorsmentioning

confidence: 99%

“…In multivariate analysis, donors with SBP ≥ 140 had significantly higher rates of death than those with measurements < 120 mmHg [25]. More recently, donor hypertension was found to be an independent predictor of longer hospital length of stay and surgical complications [29]. …”

Section: Medical Complexities At Donation and Associated Outcomesmentioning

confidence: 99%

The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient

Niemi

Mandelbrot

2013

Curr Transpl Rep

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Living kidney donation is an important option for patients with end-stage renal disease (ESRD), and has improved life expectancy and quality for patients otherwise requiring maintenance dialysis or deceased-donor transplantation. Given the favorable outcomes of live donation and the shortage of organs to transplant, individuals with potentially unfavorable demographic and clinical characteristics are increasingly being permitted to donate kidneys. While this trend has successfully expanded the live donor pool, it has raised concerns as to which acceptance criteria are safe. This review aims to summarize the existing literature on the outcomes of transplantation from medically complex, living kidney donors, including both donor and recipient outcomes when available.

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Comorbidity Burden and Perioperative Complications for Living Kidney Donors in the United States

Cited by 97 publications

References 34 publications

Critical Factors Associated With Missing Follow-Up Data for Living Kidney Donors in the United States

Critical Factors Associated With Missing Follow-Up Data for Living Kidney Donors in the United States

Better Understanding Live Donor Risk through Big Data

The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient

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