Long-term Medical Outcomes of Living Kidney Donors

Matas, Arthur J.; Rule, Andrew D.

doi:10.1016/j.mayocp.2022.06.013

Cited by 20 publications

(21 citation statements)

References 126 publications

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“…Future data collection and quality metrics could promote patient‐centered care by including patient‐centered outcomes, or encourage increased access to transplant by developing patient‐friendly prelisting metrics. Critically, long‐term data of any kind, including patient‐centered outcomes, are not collected on living donors, and efforts to collect these data to inform those considering living donation should be prioritized 43–45 . These data can also inform transplant centers regarding what information to provide on their own websites, such as the availability of patient and family support groups, participation in living donor exchanges, and important listing criteria to avoid futile transplant evaluations.…”

Section: Discussionmentioning

confidence: 99%

“You don't know what you don't know”: A qualitative study of informational needs of patients, family members, and living donors to inform transplant system metrics

Hart,

Schaffhausen,

McKinney

et al. 2024

Clinical Transplantation

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IntroductionInformational needs and potential use of transplant metrics, especially among patients, remain understudied and a critical component of the transplant community's commitment to patient‐centered care. We sought to understand the perspectives and needs of patients, family members/caregivers, living donors, and deceased donor family members.MethodsWe examined decision‐making experiences and perspectives on the needs of these stakeholder groups for data about the national transplant system among 58 participants of 14 focus groups and 6 interviews.ResultsThree major themes emerged: 1) informational priorities and unmet needs (transplantation system processes, long‐term outcomes data, prelisting data, patient‐centered outcomes, and ability to compare centers and regions); 2) challenges obtaining relevant and trustworthy information (patient burden and effort, challenges with medical jargon, and difficulty finding trustworthy information); and 3) burden of facing the unknown (stress and anxiety leading to difficulty processing information, challenges facing the transplant journey when you “don't know what you don't know”).ConclusionPatient, family member, and living donor participation in shared decision‐making has been limited by inadequate access to patient‐centered information. New metrics and patient‐facing data presentations should address these content gaps using best practices to improve understanding and support shared decision‐making.

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Section: Discussionmentioning

confidence: 99%

“You don't know what you don't know”: A qualitative study of informational needs of patients, family members, and living donors to inform transplant system metrics

Hart,

Schaffhausen,

McKinney

et al. 2024

Clinical Transplantation

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“…According to the data collected in our study, we found that despite the patient's BMI there will always be a decrease in post-donation GFR; a higher GFR was observed at the beginning of the study in patients with a normal BMI compared to the group of overweight and obese patients, and this predominant value was maintained throughout the time intervals. According to the research by Matas and Rule [20] for each unit increase in BMI above 27 there is an associated signi cant increase of 7% in the risk of end-stage CKD.…”

Section: Discussionmentioning

confidence: 99%

Evolution of renal function in living renal donors, five-year follow-up of patients operated in the same institution

Medina-Toscano,

González-Espinosa,

González-Ojeda

et al. 2024

Preprint

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Introduction: Chronic kidney disease (CKD) has become a pathology with an increase in its prevalence during the last years. Renal transplantation offers a greater survival advantage for patients with end-stage renal disease. Main long-term conditions for kidney donors, as well as their renal function and the development of renal failure is yet to be studied. Methods: Cross-sectional, analytical study from January 1, 2005 to December 31, 2012 of living renal donors who participated in the renal transplant program of the Centro Médico Nacional de Occidente of the Instituto Mexicano del Seguro Social who were > 18 years of age and who complied with follow-up for 5 years. Results: 302 living donor nephrectomies were performed, a total of 78 patients were included. The estimated mean baseline glomerular filtration rate (GFR) measured in 24-hour urine prior to donation was 120.7 ± 25.82 ml/min/1.73m2, showing a considerable decrease in the first 3 months with an average of 77.9 ± 17.58 ml/min/1.73m2 which represents a decrease of 35.4% with respect to baseline. Conclusions: There is a significant decrease in renal function in living donors during the first months after nephrectomy, but this improves with evolution, although without returning to pre-donation levels.

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“…Whether donors with a low GFR from donation alone truly have CKD has been debated, 27 but certainly when GFR is <45 ml/min per 1.73 m 2 , there will be clinical concern. These CT biomarkers were informative of the short-term and long-term risk of a low GFR of <45 or <60 ml/min per 1.73 m 2 .…”

Section: Discussionmentioning

confidence: 99%

The Number and Size of Individual Kidney Medullary Pyramids is Associated with Clinical Characteristics, Kidney Biopsy Findings, and CKD Outcomes among Kidney Donors

Gregory,

Denic,

Moustafa

et al. 2023

JASN

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Background: The kidney is a lobulated organ, but little is known regarding the clinical importance of the number and size of individual kidney lobes. Methods: After applying a previously validated algorithm to segment cortex and medulla, a deep-learning algorithm was developed and validated to segment and count individual medullary pyramids on contrast-enhanced computed tomography (CT) images of living kidney donors prior to donation. The association of cortex volume, medullary volume, number of pyramids, and mean pyramid volume with concurrent clinical characteristics (kidney function and chronic kidney disease risk factors), kidney biopsy morphology (nephron number, glomerular volume, and nephrosclerosis), and short- and long-term glomerular filtration rate (GFR) <60 or <45 ml/min/1.73m2 was assessed. Results: Among 2,876 living kidney donors, 1,132 had short-term follow-up at a median of 3.8 months and 638 had long-term follow-up at a median of 10.0 years. Larger cortical volume was associated with young age, male, larger body size, higher GFR, albuminuria, more nephrons, larger glomeruli, less nephrosclerosis, and lower risk of low GFR at follow-up. Larger pyramids were associated with older age, female, larger body size, higher GFR, more nephrons, larger glomerular volume, more nephrosclerosis, and higher risk of low GFR at follow-up. More pyramids were associated with younger age, male, greater height, no hypertension, higher GFR, lower uric acid, more nephrons, less nephrosclerosis, and a lower risk of low GFR at follow-up. Conclusions: Cortical volume and medullary pyramid volume and count reflect underlying variation in nephron number and nephron size, as well as merging of pyramids due to age-related nephrosclerosis, with loss of detectable cortical columns separating pyramids.

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Long-term Medical Outcomes of Living Kidney Donors

Cited by 20 publications

References 126 publications

“You don't know what you don't know”: A qualitative study of informational needs of patients, family members, and living donors to inform transplant system metrics

“You don't know what you don't know”: A qualitative study of informational needs of patients, family members, and living donors to inform transplant system metrics

Evolution of renal function in living renal donors, five-year follow-up of patients operated in the same institution

The Number and Size of Individual Kidney Medullary Pyramids is Associated with Clinical Characteristics, Kidney Biopsy Findings, and CKD Outcomes among Kidney Donors

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