Long-term medical risks to the living kidney donor

Abstract

Living kidney donation benefits recipients and society but carries short-term and long-term risks for the donor. This Review summarizes the studies that underlie our current understanding of these risks in the first decade after donation, with a view to improving the informed consent process. Two studies report a higher risk of end-stage renal disease (ESRD) among donors than among healthy nondonors; however, the absolute 15-year incidence of ESRD is <1%. All-cause mortality and the risk of cardiovascular events are similar among donors and healthy nondonors, although one study provides evidence for a 5% increase in all-cause mortality after 25 years that is attributable to donation. Some evidence suggests that the 20-year incidence of gout is slightly higher among donors than among healthy nondonors. The risks of gestational hypertension or pre-eclampsia seem to be 6% higher in pregnancies among donors than in pregnancies among healthy nondonors. The incidences of acute kidney injury, kidney stones that require surgical intervention, gastrointestinal bleeding and fractures seem no higher among donors than among healthy nondonors, although some of these conclusions are based on a small number of events. Future studies must clarify the lifetime incidence of long-term outcomes, particularly in relation to a donor's age, race, and history of comorbidities.

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“…A recent article described that, in donors ≥ 70 years old, mortality rate was in fact lower than in a younger cohort of donors. 8 This was attributed to a more cautious and selective work-up of the donors. 8 In another study that examined the safety and efficacy of the laparoscopic nephrectomy, no significant differences in complication rates or overall length of hospital stay were found in older versus younger donors.…”

“…8 This was attributed to a more cautious and selective work-up of the donors. 8 In another study that examined the safety and efficacy of the laparoscopic nephrectomy, no significant differences in complication rates or overall length of hospital stay were found in older versus younger donors. 9 Friedman and associates, however, showed that overall hospital stay in older donors increased on average by 0.2 days.…”

“…11 However, other studies have shown poorer graft outcomes, which were associated with higher levels of complications. 8 With increasing demand for organs, longer wait times, and more frequent deaths when waiting for organs, this lack of consensus promotes elderly kidney donation.…”

“…These donors can be a good resource for organ transplant but are at increased health-related risks compared with nondonors of the same age. [7][8][9] During the early stages of living-donor kidney programs, advanced age was widely considered as an absolute contraindication, mainly as it was deemed to increase long-term morbidity and mortality. 10,11 Patients with advanced age also were more likely to be excluded from donation because of the presence of comorbidities.…”

Gender differences in use of prescription narcotic medications among living kidney donors

“…Lastly, our non-donor comparisons used general (rather than “healthy”) controls, as we lacked sufficient capture durations to allow for screening and selection of non-donors free of baseline co-morbidity. While general population comparisons do not address risk attributable to donation, as long as the type of comparison is explicit, general population experience can provide one relevant benchmark for framing post-donation outcomes (40,54). …”