Risk of ESRD in prior living kidney donors

Abstract

We studied End-Stage Renal Disease (ESRD) in living kidney donors (LKDs) who donated in the United States between 1994 and 2016 (n = 123 526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. Two hundred eighteen LKDs developed ESRD, with a median of 11.1 years between donation and ESRD. Absolute 20-year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKDs had increased risk of ESRD if they were male (adjusted hazard ratio [aHR]: 1.75, 95% confidence interval [95%CI]: 1.33-2.31), had higher BMI (aHR: 1.34 per 5 kg/m , 95%CI: 1.10-1.64) or lower estimated GFR (aHR: 0.89 per 10 mL/min, 95% CI: 0.80-0.99), were first-degree relatives of the recipient (parent: [aHR: 2.01, 95% CI: 1.26-3.21]; full sibling [aHR: 1.87, 95%CI: 1.23-2.84]; identical twin [aHR: 19.79, 95%CI: 7.65-51.24]), or lived in lower socioeconomic status neighborhoods at donation (aHR: 0.87 per $10k increase; 95%CI: 0.77-0.99). We found a significant interaction between donation age and race, with higher risk at older ages for white LKDs (aHR: 1.26 per decade, 95%CI: 1.04-1.54), but higher risk at younger ages for black LKDs (aHR: 0.75 per decade, 95%CI: 0.57-0.99). These findings further inform risk assessment of potential LKDs.

Epidemiology of end-stage renal failure among twins and diagnosis, management, and current outcomes of kidney transplantation between identical twins

“…[17][18][19] Not surprisingly, we found that the percentage of patients main- Previous studies have reported a higher risk of subsequent ESRF among twin donors. 28 We found ESRF in 2/143 (1.4%) donors after donation. However, the cause of ESRF among the donor was unknown making it difficult to examine the potential contributors among donors.…”

GFR-related risks for kidney donors are here to stay, but what are they?

“…A recent analysis of the United Network for Organ Sharing (UNOS) registry in the American Journal of Transplantation (AJT) by Wainright et al identified predonation eGFR a as a risk factor for postdonation end-stage renal disease (ESRD). 1 Two other recent studies also seem to confirm GFR-related risks by observing that ESRD was 8-11 times more common after donation when compared to 2-kidney controls. 2,3 In these studies, ESRD rates may have been increased in donors by familial diseases or increased in controls by less thorough vetting.…”

“…Unfortunately, diabetes is increasingly common in the United States, current donor screening does not seem to predict it, and diabetic ESRD is part of the exponential increase in ESRD seen at 20 years in UNOS donors. 1,4,8 As with other de novo diseases, loss of GFR at donation should accelerate its rate of appearance. 8 Focused attempts to control postdonation obesity may reduce the impact of this important disease.…”

What’s hot, what’s new: Report from the American Transplant Congress 2018

“…Topics ranged from innovation in immunosuppressive therapy and long‐term follow‐up of living kidney donors, to the continued interest in transplanting kidneys infected with hepatitis C and utilization of direct‐acting antiviral agents in the recipients. In a report from UNOS, Wainright et al examined the incidence of end‐stage renal disease (ESRD) in living kidney donors . In the United States, 219 living kidney donors out of 123 523 total living donors developed ESRD between 1994 and 2016, highlighting the absolute low risk of ESRD.…”