Medical Risks in Living Kidney Donors

Ommen, Elizabeth S.; Winston, Jonathan; Murphy, Barbara

doi:10.2215/cjn.00840306

Cited by 85 publications

(68 citation statements)

References 83 publications

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“…There are data to suggest that long-term survival and the risk of end-stage kidney disease in kidney donors are comparable to the general population; however, the donor population are generally screened to be healthier and most studies have small sample sizes, are retrospective and subject to selection bias (19,(32)(33)(34). Of note, recent data suggest that while the absolute risk of endstage kidney disease (ESKD) within 15 years of donation is low, the incidence of end-stage kidney disease at 15 years may be eight times higher for living kidney donors than for healthy matched controls (35).…”

Section: Discussionmentioning

confidence: 99%

Living Kidney Donor Assessment: Challenges, Uncertainties and Controversies Among Transplant Nephrologists and Surgeons

Tong

Chapman

Wong

et al. 2013

American Journal of Transplantation

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The assessment of living kidney donors presents unique ethical challenges and complex psychosocial implications. This study aimed to ascertain the perspectives of transplant nephrologists and surgeons on living kidney donor assessment. Semi‐structured, face‐to‐face interviews were conducted with 110 transplant nephrologists and surgeons from 43 transplant units in 12 countries from Europe, Australasia and North America. The challenge of defining acceptable risk to the donor was central to five themes identified: burden of responsibility (personal accountability, policing morality, democratic decision making, meeting legal obligations, optimizing outcomes and innovation, relinquished control); medical protectiveness (prognostic uncertainty, skepticism of donor risk perception, avoidance of undue coercion, concerns for dubious motivations and coercion, safeguard donor well‐being, ethical information disclosure); respecting donor autonomy (facilitate informed‐decision making, concede to donor risk acceptance, benefit of the doubt, donor mandate to maintain health, acceptable altruism); driving ideologies (preserving equity, championing living donation, cognizance of anti‐paternalism) and contextual pressures (evolving donor demographic, resource limitations). Living kidney donor assessment involves complex interactions between safeguarding the donors' welfare and respecting their autonomy. In our opinion, authoritative and well‐described transplant unit, hospital and public policy positions that make explicit the considerations that are often implicit may reduce the uncertainty within which living donors are assessed today.

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Section: Discussionmentioning

confidence: 99%

Living Kidney Donor Assessment: Challenges, Uncertainties and Controversies Among Transplant Nephrologists and Surgeons

Tong

Chapman

Wong

et al. 2013

American Journal of Transplantation

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“…Nevertheless, the limited availability of organs from deceased donors and the growing demand for transplantation have produced a marked increase in living kidney donation worldwide over recent years. 3 As a result, thousands of healthy individuals are becoming uninephric every year, generating some concerns about the long-term consequences of UNX. 3,4 Data on the relationship between nephron loss and the risk of increased BP or proteinuria have not been consistent.…”

mentioning

confidence: 99%

“…3 As a result, thousands of healthy individuals are becoming uninephric every year, generating some concerns about the long-term consequences of UNX. 3,4 Data on the relationship between nephron loss and the risk of increased BP or proteinuria have not been consistent. It has been reported that the initial loss of renal function is, in part, compensated for producing a mean glomerular filtration rate that is 70% to 75% of the pre-UNX value.…”

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confidence: 99%

Long-Term Consequences of Uninephrectomy in Male and Female Rats

et al. 2012

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Abstract-We investigated the effects of uninephrectomy (UNX) in 6-week-old male and female rats on blood pressure (BP), renal sodium handling, salt sensitivity, oxidative stress, and renal injury over 18 months postsurgery, studying control sham-operated and UNX-operated rats at 6, 12, and 18 months postsurgery, evaluating their renal sodium handling, BP, urinary isoprostanes, N-acetyl-β-d-glucosaminidase, and proteinuria before and after a 2-week high-salt intake period. At 18 months, plasma variables were measured and kidney samples were taken for the analysis of renal morphology and tissue variables. BP was increased at 6 months in male UNX rats versus controls and at 12 and 18 months in both male and female UNX rats and was increased in male versus female UNX groups at 18 months. UNX did not affect water and sodium excretion under basal conditions and after the different test in male and female rats at different ages. However, the renal function curve was shifted to the right in both male and female UNX rats. Highsalt intake increased BP in both UNX groups at 6, 12, and 18 months and in the female control group at 18 months, and it increased proteinuria, N-acetyl-β-d-glucosaminidase, and isoprostanes in both UNX groups throughout the study. Renal lesions at 18 months were more severe in male versus female UNX rats. In summary, long-term UNX increased the BP, creatinine, proteinuria, pathological signs of renal injury, and salt sensitivity. Earlier BP elevation was observed and morphological lesions were more severe in male than in female UNX rats. Rodríguez-Gómez et al Effects of Uninephrectomy in Rats 1459scarcely more feasible to recruit living donors for the longterm follow-up of key renal functional and morphological parameters. With this background, the objective of the present study was to examine the consequences of UNX in male and female rats, as a model of donor nephrectomy, on BP, renal sodium handling, salt sensitivity, oxidative stress, and renal injury over 18 months and on renal pathology variables gathered at 18 months. Methods AnimalsMale and female Wistar rats born and raised in the experimental animal service of the University of Granada were used. Experiments were performed according to European Union guidelines for the ethical care of animals. At 6 weeks of age, the rats were divided into 4 groups (n=25 in each), 1 male and 1 female group for UNX and 1 male and 1 female group for sham operation (controls). In the UNX group, total extirpation of the left kidney was performed, leaving the adrenal gland intact. Sham-operated animals were prepared in the same manner, and the left kidney was handled but not removed. Postsurgery, all animals had access to standard chow and tap water ad libitum. Experimental ProtocolThe same experimental protocol was repeated in the same 8 rats from each study group at 6, 12, and 18 months after surgery in the following consecutive procedures: (1) for baseline, animals were housed in metabolic cages (Panlab, Barcelona, Spain) with food and tap water available ...

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“…Medically complex donors form a significant proportion (24%, defined as presence of hypertension, obesity, or an eGFR ,60) (10) of current donors and an even bigger fraction of those that are evaluated. There are few data on the long-term effects of donation in this population, and the few available studies are small, with heterogeneous definitions (11,12). Currently, most US transplant centers do not have long-term donor follow-up beyond the immediate postoperative period (13).…”

Section: Introductionmentioning

confidence: 99%

The Living Kidney Donor Evaluation

Kher

Mandelbrot

2012

Clinical Journal of the American Society of Nephrology

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SummaryLiving kidney donor evaluations and follow-up have previously been addressed mostly by transplant physicians and surgeons. However, this area is significantly informed by basic principles of renal physiology and is of increasing clinical interest to general nephrologists. The general nephrology community is increasingly involved in evaluating the suitability of potential donors and in following them after donation when questions are raised about low GFR, hypertension, and other renal concerns. This article focuses on some of the most central and common issues that arise in evaluating potential donors and attempts to provide guidance on the basis of our review of the living donor literature, extrapolations from the general nephrology literature, and our own clinical experience.

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Medical Risks in Living Kidney Donors

Cited by 85 publications

References 83 publications

Living Kidney Donor Assessment: Challenges, Uncertainties and Controversies Among Transplant Nephrologists and Surgeons

Living Kidney Donor Assessment: Challenges, Uncertainties and Controversies Among Transplant Nephrologists and Surgeons

Long-Term Consequences of Uninephrectomy in Male and Female Rats

The Living Kidney Donor Evaluation

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