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Estimated glomerular filtration rate (eGFR) at follow-up calculated with cystatin C and years after donation. Groups divided by pre-donation measured glomerular filtration rate (mGFR) ‡80 mL/min/1.73 m 2 (*) and <80 mL/min/1.73 m 2 (.), respectively.
Source publication
Background
The increase of live kidney donation (LKD) demands that we scrutinize its long-term consequences. Socialized medicine in Sweden has allowed us to survey long-term consequences of LKD with a high response rate.
Methods
Between 1974 and 2008, 455 LKDs were performed; 28 donors were deceased and 14 had moved abroad at the time of the surve...
Context in source publication
Context 1
... results of renal function, mean arterial pressure (MAP), and albuminuria before and after donation have been summarized in Table II. There was a statistically significant decrease in GFR when com- paring pre-donation values and values at follow-up. S-creatinine at follow-up was 93 ± 18 mmol/L, corre- sponding to a MDRD of 67 ± 13 mL/min/1.73 m 2 , Cockcroft-Gault of 76 ± 21 mL/min/1.73 m 2 , and s-cystatin C eGFR of 73 ± 18 mL/min/1.73 m 2 . Twenty-nine (7%) had a pre-donation mGFR of <80 mL/min/1.73 m 2 , but this subgroup had no significant correlation with lower eGFR at follow- up ( Figure 1). There was no case of ESRD identified in the follow-up cohort, and the lowest reported eGFR was 31 mL/min/1.73 m 2 25 years after dona- tion. There was no correlation between mean time after donation and eGFR calculated, either with MDRD or with s-cystatin C (Figure 2). At follow- up, the mean decrease in MDRD was 19 ± 15 and 15 ± 13, and mean MDRD was 69 ± 13 and 65 ± 12 mL/min/1.73 m 2 for male and female donors, respectively. The gender difference was statistically significant (p < 0.01). Pre-donation with lower mGFR (p < 0.0001), higher age (p < 0.0001), and higher BMI (p < 0.0001) correlated with lower eGFR at follow-up, but higher MAP did not (p = 0.08). When divided into age categories, both male and female donors showed better eGFR calculated with the MDRD formula if younger at the time of donation ( Figure 3). There was no correlation between pre-donation mGFR and MAP or ACR at follow-up (Figure 4). There were 42 (11%) donors who developed albu- minuria ( ‡30 mg/L albumin or ACR ‡5 mg/mmol). Two of them had urine albumin >300 mg/L. No patient was treated for hypertension before donation (Table II). At follow-up the mean systolic blood pressure (SBP) was 131 ± 17 and diastolic blood pressure (DBP) 79 ± 10 mmHg, but 101 (26%) had a SBP >140 or DBP >90 mmHg. Of concern was also that 111 (28%) of the donors had treated hypertension of whom only 52% had BP <140/90. Table II. Renal function parameters (creatinine, Modification of Diet in Renal Disease (MDRD), Cockcroft-Gault and cystatin C-estimated GFR), body mass index (BMI), mean arterial pressure (MAP), and albuminuria before donation and at follow-up. The antihypertensive treatment included ACE inhi- bitors or renin-angiotensin blockers in 73%. Only 5 donors (1%) were diagnosed with diabetes mellitus at ...
Citations
... Donor follow-up was poor during the course of the study. This remains a challenge globally as numerous international studies report similarly high lost to follow-up rates [68][69][70]. Our centre is the only state transplant facility in Johannesburg; follow-up visits thus necessitate that donors travel considerable distances at personal expense. ...
Background:
Living kidney donation has been advocated as a means to ameliorate the chronic shortage of organs for transplantation. Significant rates of comorbidity and familial risk for kidney disease may limit this approach in the local context; there is currently limited data describing living donation in Africa.
Methods:
We assessed reasons for non-donation and outcomes following donation in a cohort of 1208 ethnically diverse potential living donors evaluated over a 32-year period at a single transplant centre in South Africa.
Results:
Medical contraindications were the commonest reason for donor exclusion. Black donors were more frequently excluded (52.1% vs. 39.3%; p<0.001), particularly for medical contraindications (44% vs. 35%; p<0.001); 298 donors proceeded to donor nephrectomy (24.7%). Although no donor required kidney replacement therapy, an estimated glomerular filtration rate below 60 ml/min/1.73 m2 was recorded in 27% of donors at a median follow-up of 3.7 years, new onset albuminuria >300 mg/day was observed in 4%, and 12.8% developed new-onset hypertension. Black ethnicity was not associated with an increased risk of adverse post-donation outcomes.
Conclusion:
This study highlights the difficulties of pursuing live donation in a population with significant medical comorbidity, but provides reassurance of the safety of the procedure in carefully selected donors in the developing world.
... It has been found that kidney function might be impaired immediately after donation and recovers within the first year. Previous studies suggest that renal function reached at 1 year postdonation remains stable at least for over the next decade but then impaired with ageing 6 . ...
Objectives To assess the health related quality of life of living related donors after kidney transplantation and to evaluate clinical ,social and psychological condition post donation Study design This is an observational cross sectional study that included fifty living related donors of kidney transplant. All donors were assessed after at least one year of kidney donation. Data of the study was collected between April, 2019 and March, 2020. Methods The study included 50 living related donors;All donors were assessed after at least one year of kidney donation.WHOQOL-bref questionnaire (world health organization quality of life) was used to assess quality of life of donors. Results The mean age at time of transplantation was 35.4±7.89 years. Eight cases developed hypertension after transplantation. There was no significant difference between serum creatinine before and after transplantation while there was significant decrease in glomerular filtration rate post transplantation. There was significant increase in fasting blood glucose and cholesterol in female donors compared to males.The results of the WHOQOL-bref questionnaire showed significant difference in results of psychological, social and environmental domains pre and post donation. Conclusion Proper selection of donors is very important to avoid complications post transplantation. Follow-up of donors should be maintained after donation.
... The lack of an ethnicity-related effect to the recovery of kidney function could encourage potential living donors from African and Asian communities to proceed with donation; this is most important, considering the fact that these minority groups are more likely to deny consent for deceased organ donation, while at the same time they face prolonged waiting times due to difficulties in the matching process independently from the allocation policy [18,19]. In our centre, practicing in a multi-ethnic country like the UK, we focus on educational programmes directed to ethnic minorities to assure potential donors of the long-term safety of living kidney donation; the results of this study and similar findings in other cohorts [20,21] are informing the content of those programmes. ...
... Similarly to other studies, we demonstrated that the lowest eGFR is within 6 months of follow up [20], and it is statistically significantly related to age older than 60 years [21] and male sex [15]. It is interesting to note that the mean eGFR is higher pre-donation for males, and after donation there is no difference during the 60 months follow up. ...
Introduction:
There is a great need to increase the organ donor pool, particularly for living donors. This study analyses the difference in post-living donation kidney function according to pre-donation characteristics of age, genetic relationship with the recipient, sex, ethnicity, and Body Mass Index (BMI).
Methods:
Retrospective single centre analysis of the trajectory of estimated Glomerular Filtration Rate (eGFR) post-living kidney donation, as a measure of kidney function. Mean eGFR of the different groups was compared at 6 months and during the 60 months follow up.
Results:
Mean age was 46 ± 13 years, 57% were female, and 60% Caucasian. Mean BMI was 27 ± 5 kg/m2, with more than a quarter of the cohort having a BMI > 30 (26%), and the majority of the donors genetically related to their recipients (56%). The higher decline rate in eGFR was at 6 months after donation, with female sex, non-Caucasian ethnicity, and age lower than 60 years being independently associated with higher recovery in kidney function (p < 0.05). In the 60 months follow up, older age, genetic relationship with the recipient, and male sex led to higher percentual difference in eGFR post-donation.
Conclusion:
In this study, with a high proportion of high BMI living kidney donors, female sex, age lower than 60 years, and non-genetic relationship with recipient were persistently associated with higher increase in post-donation kidney function. Ethnicity and BMI, per se, should not be a barrier to increasing the living donor kidney pool.
... All of the donors in our study had check-ups with a physician or nurse, measurement of blood pressure, and blood and urine tests. In Sweden, where 50-82% of kidney donors attend regular check-ups and have long-term follow-up, hypertension has been observed in about half of donors, and the blood pressure of half of those hypertensive donors is not optimally treated [15,22,23]. Among the LADs, hypertension was discovered during follow-up in 4 out of 24 (17%) patients. ...
Background
Living anonymous donation (LAD) of kidneys was introduced in Sweden in 2004. This study reports on outcomes of Swedish LAD experiences from 2004 to 2016, focusing on donors’ motives, the care they received, psychosocial aspects, and medical status at follow-up.
Material/Methods
Donor data were collected through a physician interview, medical check-up, review of medical charts, the Hospital Anxiety Depression Scale (HADS), and a routine national questionnaire. Of the 26 LADs during the study period, 1 donor died and 1 declined to participate, leaving a study population of 24.
Results
Half of the donors were male, which is a higher proportion than for directed living donors. The major motive detected was altruism. Of the 24 LADs, 96% were very satisfied and would donate again if possible, 46% noted increased self-esteem, and a third were happier after the donation. Sixty-two percent received anonymous information about the recipient and 40% would have liked to meet the recipient. HADS scores were normal. Two donors had antidepressant treatment, 1 of whom had received treatment before donation. Half mentioned that the pre-donation assessment took too long. At follow-up, mean eGFR was 62±12 mL/min/1.73 m², of which 16 were in CKD II and 8 were in CKD III. Four donors had developed hypertension, 1 of whom also developed type 2 diabetes.
Conclusions
Swedish LADs are very satisfied and medical outcomes are acceptable. We propose that the transplant community and the National Board of Health and Welfare take a more active approach to informing the general public about LAD.
... When caregivers become donors, an additional issue arises viz., of their own long-term health and well-being. While it is established that unilateral nephrectomy is safe for the donor in the long run with respect to maintenance in glomerular filtration rate (GFR), hypertension and heart disease [5,6], the psychosocial and quality of life impact is less wellknown [7][8][9]. Many authors feel that long-term psychological and mental health outcomes in living donors may be consequent to pre-operative and postoperative variables like pre-existing anxiety or recipient complications; these need to be studied in greater detail. ...
... No case of ESRD was identified in the follow-up cohort and the lowest reported eGFR was 31 mL/min/1.73 m 2 at 25 years after donation [10]. To further address the gender imbalance in live kidney donation, in this study we analyzed gender differences in attitudes, motives, experiences, and follow-up after live kidney donation. ...
Background
We sought to study gender differences and differences over time with respect to demographics, relation to recipient, donor motives, and experiences of live kidney donation.
Material/Methods
In all, 455 consecutive live kidney donors, representing all of the donors at our center between 1974 and 2008 were considered for this study. There were 28 deceased donors and 14 donors who had moved abroad, leaving 413 donors; 387 (94%) agreed to participate in this study. A questionnaire was sent and the answers was analyzed for gender differences and, where relevant, for changes over time.
Results
In all sub-periods, female donors made up the majority (55–62%), except for sibling donors (45%) and child-to-parent donors (40%). No significant gender differences were seen in perceived information given before donation. For males, it was more common that the recipient took the initiative to donate. For females, the motivation for donating was more frequently to help the recipient and because others wanted them to donate. For males, it was more common to feel a moral obligation. Post-operatively, females more frequently felt sad and experienced nausea, and more frequently felt that the donation had a positive impact on their lifes. With the introduction of minimally invasive surgical techniques, donors experienced fewer problems from the operation, with no gender difference.
Conclusions
Females donate more frequently than males, a difference that did not change over time. Only a few gender differences were seen in donor motives and the donation experience; however, these differences may be relevant to address the gender imbalance in kidney donations.
... Mean age was similar with our study. 16 Another study with 6 months' follow-up showed similar GFR loss in donors. 17 ESRD risk seems lower in kidney donors, but some studies report increased ESRD risk especially in African American donors. 2 Kidney donors show similar characteristics after nephrectomy. ...
Background
Urinary angiotensinogen (uAGT) has recently been proposed as a marker of kidney injury and activated intrarenal renin–angiotensin system. We investigated the effects of living donor nephrectomy on uAGT levels, blood pressure, estimated glomerular filtration rate, proteinuria and compensatory hypertrophy in the remaining kidney of living kidney donors.
Methods
Twenty living kidney donors were included in the study and followed for 1 year. uAGT levels were measured with enzyme-linked immunosorbent assay preoperatively and postoperatively at the 15th day, 1, 6 and 12 months.
Results
Four donors were excluded from the study due to lack of data. The mean baseline estimated glomerular filtration rate was 98 ± 15 ml/min/1.73 m². Serum creatinine, uAGT/creatinine, uAGT/protein levels were higher and estimated glomerular filtration rate was lower than baseline values at all time periods. Urinary protein/creatinine levels increased after donor nephrectomy, but after 6 months they returned to baseline values. Renal volume increased after nephrectomy, but these changes did not show any correlation with uAGT/creatinine, uAGT/protein, estimated glomerular filtration rate or systolic/diastolic blood pressures. uAGT/creatinine at 6 months and urinary protein/creatinine ratio at 12 months showed a positive correlation (P=0.008, r=0.639).
Conclusion
After donor nephrectomy, increasing uAGT levels can be the result of activation of the intrarenal renin–angiotensin system affecting the compensatory changes in the remaining kidney. The long-term effects of increased uAGT levels on the remaining kidney should be examined more closely in future studies.
... Our systematic review includes five studies that compared long-term outcomes of kidney donors by pre-donation BMI, (Gracida et al., 2003;Gross et al., 2013;Ibrahim, Foley, et al., 2009;Mjoen et al., 2014;von Zur-Muhlen et al., 2014) BMI was not associated with all-cause mortality or ESRD in a cohort of donors and matched healthy non-donors. (Mjoen et al., 2014) Higher BMI was associated with lower GFR at follow-up, greater risk of hypertension (Ibrahim, Foley, et al., 2009;von Zur-Muhlen et al., 2014) and greater odds of physical component of health related quality of life impairment. ...
... Our systematic review includes five studies that compared long-term outcomes of kidney donors by pre-donation BMI, (Gracida et al., 2003;Gross et al., 2013;Ibrahim, Foley, et al., 2009;Mjoen et al., 2014;von Zur-Muhlen et al., 2014) BMI was not associated with all-cause mortality or ESRD in a cohort of donors and matched healthy non-donors. (Mjoen et al., 2014) Higher BMI was associated with lower GFR at follow-up, greater risk of hypertension (Ibrahim, Foley, et al., 2009;von Zur-Muhlen et al., 2014) and greater odds of physical component of health related quality of life impairment. (Gross et al., 2013) The quality of evidence was very low for all outcomes. ...
... 23 A few studies of variable quality examined associations between BMI and intermediate outcomes. 140,244,258 Multiple prior guidelines for the evaluation and care of living kidney donor candidates recommend BMI greater than 35 kg/m 2 as an absolute or relative contraindication to donation. 38,48,50,54,196,215,259 and other guidelines recommend careful evaluation for other comorbidities in donor candidates with BMI greater than 30 kg/m 2 . ...
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.
In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1–S109.
... Microalbuminuria is an early marker of glomerular injury (National Kidney Foundation Kidney Disease Outcomes Quality Initiative 2002), and most studies with long-term follow-up of living kidney donors have reported the presence of microalbuminuria in these patients (Gossmann et al. 2005;Von Zur-Muhlen et al. 2014). ...
... The most recent studies reported that the renal function of the donor's remaining kidney does not deteriorate faster than expected based on age, resulting in no excess risk of terminal kidney disease (Fehrman-Ekholm et al. 2001;Garg et al. 2006;Louvar et al. 2007;Ibrahim et al. 2009;Oppenheimer Salinas 2010;Wafa et al. 2011;Von Zur-Muhlen et al. 2014;Lenihan et al. 2015). ...
Background:
The increase in candidates for kidney transplant has led to growth in the number of living donor transplants. Therefore, studies that adequately evaluate the possible long-term consequences of elective transplant nephrectomy are needed.
Objective:
To evaluate the possible long-term adverse effects of transplant nephrectomy on the renal function of living kidney donors.
Design:
A cross-sectional study.
Participants:
Thirty-three living kidney donors registered in the transplant programme of a centre in Alagoas, Brazil.
Measurements:
Demographic characteristics, anthropometric measures, clinical data and biomarkers (creatinine, eGFR, microalbuminuria, cholesterol and triglycerides) were measured. Creatinine clearance was calculated using the Cockcroft-Gault and Modification of Diet in Renal Disease formulae.
Results:
Of the 33 individuals, 63.63% were female, and the median age was 45 years. Additionally, 24.24% of these individuals had altered blood pressure, 39.39% had altered abdominal circumference (AC) and 36.36% were obese, with a body mass index ≥30. Furthermore, 33.33% of these individuals had elevated triglyceride levels. The average eGFR was 97.33 (33.03-175.9) ml/min/1.73 m(2) (CG) and 84.14 (29.4-131) ml/min/1.73 m(2) (MDRD). The microalbuminuria level was altered in 12.12% patients.
Conclusion:
Kidney donation is unquestionably a safe procedure. However, a better understanding of the long-term consequences of living donor kidney transplantation is still needed. This knowledge may have important implications for the follow-up of these patients. Our study has demonstrated a non-negligible presence of an early marker of glomerular injury and a decrease in the GFR of some patients, thereby reinforcing the proposal for long-term follow-up of living kidney donors.
