Survival in Living Kidney Donors: An Australian and New Zealand Cohort Study Using Data Linkage

Abstract

The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.

Lean body mass in living kidney donors impacts postoperative renal function

“…No fatalities or chronic renal failure requiring dialysis has occurred in any donor related to their kidney donation since the commencement of the program in 2009 [ 1 ]. In keeping with international standards, mortality within the donor group is lower than general population which is reassuring for clinicians when consenting to any potential donors [ 25 ].…”

Shift in Living Kidney Donor Demographics Over the Past 50 Years in a German Transplant Center

“…Recently, living kidney data from the Australian and New Zealand Living Kidney Donor Registry, including all 3253 donors in Australia from 2004 to 2013 and in New Zealand from 2004 to 2012, were published [ 15 ]. Donor characteristics were nearly the same as those of the living kidney donors from 2000 to 2016 at our center, with 57% female donors and a median age at the time of donation of 50 (IQR 42–58) years, with 7.7% of donors ≥65 years old.…”

National and international kidney failure registries: characteristics, commonalities, and contrasts

“…Kidney failure registries are also increasingly utilised to support epidemiologic [4][5][6] , health outcomes [7][8][9][10] and health economics 11 research (Figure 2). Such findings are predominantly: (1) hypothesis generating, thus supporting the future design of interventional trials 12 or (2) prognostic, thus guiding patient counselling and clinical decision making, as well as public health interventions [7][8][9][10][13][14][15][16][17] . The strength of registry-based research is the ability to study population-based cohorts under real world conditions with longitudinal follow-up, overcoming some of the limitations of single-centre reports (uncertain generalizability) and randomised controlled trials (highly selected patient cohorts, shorter followup).…”