Hospitalizations Following Living Donor Nephrectomy in the United States

Abstract

SummaryBackground and objectives Living donors represented 43% of United States kidney donors in 2012. Although research suggests minimal long-term consequences of donation, few comprehensive longitudinal studies for this population have been performed. The primary aims of this study were to examine the incidence, risk factors, and causes of rehospitalization following donation.Design, setting, participants, & measurements State Inpatient Databases (SID) compiled by the Agency for Healthcare Research and Quality were used to identify living donors in four different states between 2005 and 2010 (n=4524). Multivariable survival models were used to examine risks for rehospitalization, and patient characteristics were compared with data from the Scientific Registry of Transplant Recipients (SRTR). Outcomes among patients undergoing appendectomy (n=200,274), cholecystectomy (n=255,231), and nephrectomy for nonmetastatic carcinoma (n=1314) were contrasted.Results The study population was similar to United States donors (for SRTR and SID, respectively: mean age, 41 and 41 years; African Americans, 12% and 10%; women, 60% and 61%). The 3-year incidence of rehospitalization following donation was 11% for all causes and 9% excluding pregnancy-related hospitalizations. After censoring of models for pregnancy-related rehospitalizations, older age (adjusted hazard ratio [AHR], 1.02 per year; 95% confidence interval [95% CI], 1.01 to 1.03), African American race (AHR, 2.16; 95% CI, 1.54 to 3.03), depression (AHR, 1.88; 95% CI, 1.12 to 3.14), hypothyroidism (AHR, 1.63; 95% CI, 1.06 to 2.49), and longer initial length of stay were related to higher rehospitalization rates among donors. Compared with living donors, adjusted risks for rehospitalizations were greater among patients undergoing appendectomy (AHR, 1.58; 95% CI, 1.42 to 1.75), cholecystectomy (AHR, 2.25; 95% CI, 2.03 to 2.50), and nephrectomy for nonmetastatic carcinoma (AHR, 2.95; 95% CI, 2.58 to 3.37). Risks for rehospitalizations were higher among African Americans than whites in each of the surgical groups.Conclusions The SID is a valuable source for evaluating characteristics and outcomes of living kidney donors that are not available in traditional transplant databases. Rehospitalizations following donor nephrectomy are less than seen with other comparable surgical procedures but are relatively higher among donors who are older, are African American, and have select comorbid conditions. The increased risks for rehospitalizations among African Americans are not unique to living donation.

Risk of ESRD in prior living kidney donors

“…We calculated the predicted absolute risk over 5-, 10 Several of our results support findings of past research conducted with other cohorts, including concern about high BMI at donation, a modifiable risk factor, 12,14 and donor sex, with male donors being at greater risk. 4,[12][13][14][15]53 We have also expanded on others' findings, including the interaction between age at donation and race found in prior research.…”

“…In addition to the small perioperative risks of donation [7][8][9][10] and mixed evidence for longer-term mortality, 3,7,11 there is new awareness of increased risk of nonrenal morbidity for LKDs. 2,5 Understandably, however, the largest focus has been on postdonation kidney function, with recent studies finding an increase in risk of End-Stage Renal Disease (ESRD) among LKDs relative to comparably healthy nondonors.…”

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

“…The interpretation for the elevated risk of missing data for donors with reported cigarette use is not entirely clear, but may reflect behavioral attributes or disinclination to receive general healthcare among these donors. The study also demonstrates that black donors are less likely to have documented follow-up information despite reports that this population has relatively increased risks of morbidity related to donation (5,16,(30)(31)(32). Interestingly, widowed donors also are associated with higher rates of missing data, which potentially could be related to relatively lower social support or psychological conditions (33,34).…”

“…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).…”

Living-Donor Kidney Transplantation

“…These factors affect LKDs' out-of-pocket costs. Additionally, although hospitalizations among past LKDs are low (e.g., less than those for patients after appendectomy), they are still 11% at 3 years after donation (26).…”