Living Related Kidney Donors

Abstract

Living related donor (LRD) nephrectomies are controversial due to the risks to the donor and improved cadaveric graft survival using cyclosporine A. Between December 22, 1970, and December 31, 1984, 1096 renal transplants were performed at a single institution, 314 (28.6%) from LRD. The average age was 34.3 years (range: 18-67); none had preoperative hypertension. All nephrectomies were performed transabdominally. Major perioperative complications occurred in 22 (7.0%). These include wound infections (3.5%), pancreatitis (1.0%), injuries to spleen (1.0%) or adrenal gland (0.3%) requiring removal, pneumonitis (0.6%), ulnar nerve palsy (0.6%), femoral artery thrombosis after arteriogram (0.3%), pulmonary embolus (0.3%), and upper pole infarct of contralateral kidney (0.3%). There are six known deaths in this series, none of which were related to the operation. Major late complications were seen in 50 (20.0%) of 250 patients followed for 6 to 175 months (mean 53.1 months). These included definite hypertension (5.6%), suture granuloma (4.4%), incisional hernia (3.6%), proteinuria (2.4%), bowel obstruction (2.0%), nephrolithiasis (1.2%), wound infection (0.4%), scrotal hydrocele (0.4%), and chronic pancreatitis (0.4%). While the risk of hypertension appears to increase as the interval from donation increases, no cases of renal failure after donation have been noted, and negligible proteinuria among those followed long-term has been seen in this series. It is felt that living related kidney donation is justified when the relative is sincerely motivated and well informed prior to donation.

Association of mGFR of the Remaining Kidney Divided by Its Volume before Donation with Functional Gain in mGFR among Living Kidney Donors

“…In our cohort, mean mGFR at 5 years after donation was, on average, 34% lower than average global mGFR before donation. The decrease in the initial global GFR ranged between 7% and 33% in the five previous studies that have estimated (and not measured) the GFR 4-6 years after donation, a postdonation period similar to the one of our cohort (24)(25)(26)(27)(28). However, in these past studies, time at GFR estimation postdonation ranged from 0.1 to 19 years, explaining the discrepancy between the observed results.…”

Medical Risks in Living Kidney Donors

“…The (10,11,13,19,25). The sum of the results of these five studies can be interpreted as showing that there is likely an increase in hypertension and proteinuria in male donors and, not unexpected, a loss of renal function of at least 20% in both genders.…”

“…In several studies, measurement was not standardized, or results were determined by patient self-report (13,17,19,24,39,40), thereby increasing chances of measurement errors and decreasing the chance of detecting a true difference in BP or hypertension in donors. The definition of hypertension has changed over time, and early studies (11,12,14,18,23) used cutoff points for hypertension that would not be considered acceptable today, whereas other studies (14,41,42) provided no definition of hypertension.…”

“…In a study of the Framingham cohort, women and men with high-normal BP (130 to 139/85 to 89) had a 60 and 150% greater rate, respectively, of CV events than those with BP Ͻ120/80 (61). Several studies have found that BP not only increases after donation but also increases with time after donation; in several of these studies, increases in BP were independent of age (13,14,47,63,64).…”

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“…7 Almost all transplant units continue to recommend livingdonor renal transplant if suitable individuals volunteer to donate their organs. 8,9 …”