Very long-term follow-up of living kidney donors

Fournier, Catherine; Pallet, Nicolas; Cherqaoui, Zoubair; Pucheu, Sylvie; Kreis, Henri; Méjean, Arnaud; Timsit, Marc‐Olivier; Landais, Paul; Legendre, Christophe

doi:10.1111/j.1432-2277.2012.01439.x

Cited by 64 publications

(47 citation statements)

References 15 publications

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“…In a single-center study in the United States, Ibrahim et al compared donor survival (n=3698) with survival in the age-, sex-, and ethnicitymatched general population and found no difference between groups (11). Similar findings have now been reported from Japan, Norway, and France (12)(13)(14). Each of these studies has two limitations: (1) the relatively small n values (especially compared with the population studies showing a relationship between reduced eGFR and mortality) ( Table 1 versus Table 7) and (2) the use of general population controls.…”

Section: Long-term Survival After Donationmentioning

confidence: 70%

“…In contrast, patients undergoing unilateral nephrectomy (for cause or for kidney donation) with a normal kidney on the contralateral side have reduced GFR for a unique reason. No data support increased risks in these populations (5)(6)(7)(8)(9)(10)(11)(12)(13)(14)37,38).…”

Section: Definition Of Ckdmentioning

confidence: 99%

“…Some kidney donors have developed ESRD (10)(11)(12)14,48,49). In the largest series to date, Cherikh et al reported that 126 former donors have been put on the waiting list for transplantation in the United States (48).…”

Section: Risk For Esrdmentioning

confidence: 99%

“…The degree of CKD in earlier studies cannot be ascertained because the use of the GFR threshold of 60 ml/min per 1.73 m 2 to diagnose CKD is a new development. Several studies from around the world have now compared long-term survival after donor nephrectomy with survival in the general population (Table 5) (8,(11)(12)(13)(14). In a single-center study from Sweden, Fehrman-Ekholm et al compared donor survival (n=430) with expected survival calculated from mortality data in the Swedish general population using age-, sex-, and calendar-yearspecific mortality rates, concluding that kidney donors live longer than would be expected (8).…”

Section: Long-term Survival After Donationmentioning

confidence: 99%

“…Laparoscopic nephrectomy is associated with quicker recovery than open nephrectomy but carries similar risk. To date, long-term follow-up studies report that donors, compared with controls, have similar or better survival rates, and perhaps lower rates of development of ESRD (5)(6)(7)(8)(9)(10)(11)(12)(13)(14). In addition, donor quality of life after donation is excellent (15).…”

mentioning

confidence: 99%

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The Unjustified Classification of Kidney Donors as Patients with CKD

Matas

Ibrahim

2013

Clinical Journal of the American Society of Nephrology

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SummaryUnilateral nephrectomy for kidney donation results in loss of about 30% of baseline GFR, leaving some donors with GFR <60 ml/min per 1.73 m 2 , the threshold for the diagnosis CKD. This has resulted in insurability problems for some donors. This article reviews the definition of CKD, risks associated with CKD, and large follow-up studies on the vital status and risk of ESRD in kidney donors. It also provides evidence that kidney donors, despite having reduced GFR, are not at increased risk for CKD-associated morbidity and mortality. Epidemiologic studies, most with follow-up <10 years, have shown an association between GFR <60 ml/min per 1.73 m 2 and higher mortality and progression to ESRD. Low GFR in the absence of any other markers for kidney disease, however, conveys attenuated or minimal risk. Of note, studies of long-term kidney donor outcomes (6-45 years) have not shown excess mortality or ESRD. The limitation of the collective evidence is that the increased risks associated with GFR <60 ml/min per 1.73 m 2 were demonstrated in much larger cohorts than those reported for kidney donor outcomes, but donor outcome studies have substantially longer follow-up. On the basis of current findings, kidney donors with low GFR and no other signs of kidney disease should not be classified as having CKD. This is definitely not the reward they deserve, and, more important, the implications of reduced GFR in donors are not associated with unfavorable outcomes. In addition, the increasing number of patients who are interested in and are eligible for a kidney transplant has not been associated with a commensurate increase in the number of DD organs. This has resulted in a markedly longer waiting time on the list. The increasing waiting time for a DD transplant and the poor shortand mid-term results with dialysis have put increased emphasis on living donation. The major disadvantage of an LD transplant is the risk to the donor. Studies over the last three decades have noted a perioperative donor mortality rate of 3 in 10,000 (0.03%) and a major complication rate of ,1% (3-5). Laparoscopic nephrectomy is associated with quicker recovery than open nephrectomy but carries similar risk. To date, long-term follow-up studies report that donors, compared with controls, have similar or better survival rates, and perhaps lower rates of development of . In addition, donor quality of life after donation is excellent (15). Of concern, however, is that recent studies in the nondonor general population have suggested that reduced renal function is associated with increased cardiovascular and all-cause mortality; consequently, some former donors have had problems obtaining life and health insurance or are being forced to pay higher premiums (16,17). At the same time, some former donors with stable renal function have been labeled as having CKD. Herein, we review level of renal function after donation and the data on long-term survival and risk of ESRD after kidney donation. Definition of CKDMany observation studies have shown the a...

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Section: Long-term Survival After Donationmentioning

confidence: 70%