Impact after live donor nephrectomy: a comparative follow-up study

S. Janki, A. Dehghan, J. van de Wetering, E. Steyerberg, K.W.J. Klop, H.J.A.N. Kimenai, D. Rizopoulos, E.J. Hoorn, S. Stracke, W. Weimar, H. Völzke, A. Hofman, J.N.M. IJzermans

Friday 16 march 2018

10:30 - 10:40h at Van Rijck/Ruys Zaal

Categories: Clinical, Session (parallel)

Parallel session: Parallel session 15: Clinical

Introduction

Worldwide, tens of thousands of healthy individuals participate in living kidney donation programs to help patients with end-stage renal disease.Potential living donors are exhaustively screened by transplant professionals, who select only those whose health will not be compromised by donation. The past years, single-center and national registry studies on long-term follow-up outcomes comparing donors to non-donors have reported unfavourable results.

Methods

We conducted a follow-up study of 761 living kidney donors from The Netherlands using individual level donor data who were propensity-score matched with 1522 non-donors from two Western population-based cohort studies on age, gender, BMI, ethnicity, kidney function, blood pressure, pre-existing co-morbidity, smoking, alcohol use and highest education degree. Live kidney donations occurred between 1981 through 2010 with follow-up until April 20th, 2016. The median follow-up time after donation was 8.0 years. The primary outcome was kidney function as defined by creatinine level and eGFR (as measured by CKD-Epi formula) at follow-up.

Results

One-year median eGFR was 59.0 ml/min/1.73 m² (IQR 50.5-68.6 ml/min/1.73 m²) and eGFR at follow-up was 59.9 ml/min/1.73 m² (IQR 51.4-70.7 ml/min/1.73 m²). Donors were found to have an increased serum creatinine of 26.03 μmol/l (95%CI 24.17; 27.89), a decreased eGFR of 27.23 ml/min/1.73m² (95%CI -28.61; -25.85), and eGFR decline of 31.70% (95%CI 29.94-33.46) as compared to non-donors at follow-up. There was no difference in outcome between donors and non-donors for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and cardiovascular mortality. A lower risk of new-onset hypertension (OR 0.45, 95%CI 0.33; 0.62) was found among donors. The EQ-5D health-related quality of life was higher among donors, while the SF-12 physical and mental component scores were lower.

Conclusion

In conclusion, one year after donation live donors have a reduced renal function, remaining stable without any kidney-related morbidity or mortality to at least eight years of follow-up. However, the decline in renal function may be further compromised when unforeseen conditions would develop that additionally affect renal function. Having knowledge of this risk, albeit small, donors should be well-informed by the medical team and offered lifelong follow-up to monitor the remnant renal function.