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Long-Term Outcomes for Living Donors

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Living Kidney Donation

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Abstract

Living kidney donors expose themselves to risk for helping others. The last decade has seen a surge of publications on long-term risks in donors. Several of these publications have uncovered increased long-term risks after living kidney donation. This represents a departure from the previous paradigm that living donor nephrectomy was a safe procedure, without any long-term risks of concern. Mainly, recent studies have included more adequate control groups than previous studies. Instead of comparing healthy kidney donors against individuals from the general population, these studies have tried to include controls that were as healthy as the kidney donors at the time of the donor nephrectomy, although with varying success. In this chapter we describe some specific long-term risks. Several studies have found increased risk of hypertension, and some studies have found increased risk of ESKD. One study even showed increased long-term mortality. We discuss the consequences of these recent findings and explore different ways to mitigate risk, especially in relation to donor selection. Although there is still considerable uncertainty regarding how to present these risks to potential donors. Finally, there are recommendations for future research in the field.

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References

  1. Merrill JP, Murray JE, Harrison JH, Guild WR. Successful homotransplantation of the human kidney between identical twins. J Am Med Assoc. 1956;160(4):277–82.

    Article  CAS  PubMed  Google Scholar 

  2. Murray JE, Merrill JP, Harrison JH. Kidney transplantation between seven pairs of identical twins. Ann Surg. 1958;148(3):343–59.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  3. Kasiske BL. Outcomes after living kidney donation: what we still need to know and why. Am J Kidney Dis. 2014;64(3):335–7.

    Article  PubMed  Google Scholar 

  4. Najarian JS, McHugh LE, Matas AJ, Chavers BM. 20 years or more of follow-up of living kidney donors. Lancet. 1992;340(8823):807–10.

    Article  CAS  PubMed  Google Scholar 

  5. Enger E. Functional compensation of kidney function in recipients and donors after transplantation between related subjects. Scand J Urol Nephrol. 1973;7(2):200–4.

    Article  CAS  PubMed  Google Scholar 

  6. Narkun-Burgess DM, Nolan CR, Norman JE, Page WF, Miller PL, Meyer TW. Forty-five year follow-up after uninephrectomy. Kidney Int. 1993;43(5):1110–5.

    Article  CAS  PubMed  Google Scholar 

  7. Fehrman-Ekholm I, Blinder CG, Stenbeck M, Tydén G, Groth CG. Kidney donors live longer. Transplantation. 1997;64(7):976–8.

    Article  CAS  PubMed  Google Scholar 

  8. Fehrman-Ekholm I, Nordén G, Lennerling A, Rizell M, Mjörnstedt L, Wramner L, et al. Incidence of end-stage kidney disease among live kidney donors. Transplantation. 2006;82(12):1646–8.

    Article  PubMed  Google Scholar 

  9. Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, et al. Long-term consequences of kidney donation. N Engl J Med. 2009;360(5):459–69.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  10. Okamoto M, Akioka K, Nobori S, Ushigome H, Kozaki K, Kaihara S, et al. Short- and long-term donor outcomes after kidney donation: analysis of 601 cases over a 35-year period at Japanese single center. Transplantation. 2009;87(3):419–23.

    Article  PubMed  Google Scholar 

  11. Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, et al. KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Transplantation. 2017;101(8):S1–109.

    Article  PubMed  Google Scholar 

  12. Lin J, Kramer H, Chandraker AK. Mortality among living kidney donors and comparison populations. N Engl J Med. 2010;363(8):797–8.

    Article  CAS  PubMed  Google Scholar 

  13. Matsushita K, van der Velde M, Astor BC, Woodward M, Levey AS, de Jong PE, et al. Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis. Lancet. 2010;375(9731):2073–81.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Wang Y, Katzmarzyk PT, Horswell R, Zhao W, Johnson J, Hu G. Comparison of the heart failure risk stratification performance of the CKD-EPI equation and the MDRD equation for estimated glomerular filtration rate in patients with Type 2 diabetes. Diabet Med. 2016;33(5):609–20.

    Article  CAS  PubMed  Google Scholar 

  15. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu C. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med. 2004;351(13):1296–305.

    Article  CAS  PubMed  Google Scholar 

  16. D’Agati VD, Chagnac A, De Vries APJ, Levi M, Porrini E, Herman-Edelstein M, et al. Obesity-related glomerulopathy: clinical and pathologic characteristics and pathogenesis. Nat Rev Nephrol. 2016;12(8):453–71.

    Article  PubMed  Google Scholar 

  17. Denic A, Mathew J, Lerman LO, Lieske JC, Larson JJ, Alexander MP, et al. Single-nephron glomerular filtration rate in healthy adults. N Engl J Med. 2017;376(24):2349–57.

    Article  PubMed  PubMed Central  Google Scholar 

  18. Locke JE, Reed RD, Massie A, MacLennan PA, Sawinski D, Kumar V, et al. Obesity increases the risk of end-stage kidney disease among living kidney donors. Kidney Int. 2017;91(3):699–703.

    Article  PubMed  Google Scholar 

  19. Grams ME, Sang Y, Levey AS, Matsushita K, Ballew S, Chang AR, et al. Kidney-failure risk projection for the living kidney-donor candidate. N Engl J Med. 2016;374(5):411–21.

    Article  CAS  PubMed  Google Scholar 

  20. Serrano OK, Sengupta B, Bangdiwala A, Vock DM, Dunn TB, Finger EB, et al. Implications of excess weight on kidney donation: long-term consequences of donor nephrectomy in obese donors. Surgery. 2018;164(5):1071–6.

    Article  PubMed  Google Scholar 

  21. Kiberd BA, Tennankore KK. Lifetime risks of kidney donation: a medical decision analysis. BMJ Open. 2017;7(8):e016490.

    Article  PubMed  PubMed Central  Google Scholar 

  22. Segev DL, Muzaale AD, Caffo BS, Mehta SH, Singer AL, Taranto SE, et al. Perioperative mortality and long-term survival following live kidney donation. J Am Med Assoc. 2010;303(10):959–66.

    Article  CAS  Google Scholar 

  23. Garg AX, Meirambayeva A, Huang A, Kim J, Prasad GVR, Knoll G, et al. Cardiovascular disease in kidney donors: matched cohort study. BMJ. 2012;344(7850):18.

    Google Scholar 

  24. Mjøen G, Hallan S, Hartmann A, Foss A, Midtvedt K, Øyen O, et al. Long-term risks for kidney donors. Kidney Int. 2014;86(1):162–7.

    Article  PubMed  Google Scholar 

  25. Reese PP, Bloom RD, Feldman HI, Rosenbaum P, Wang W, Saynisch P, et al. Mortality and cardiovascular disease among older live kidney donors. Am J Transplant. 2014;14(8):1853–61.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  26. Haugen AJ, Mjøen G. Living donation—any news on the donor? Curr Opin Organ Transplant. 2021;26(1):85–90.

    Article  PubMed  Google Scholar 

  27. Kim Y, Yu MY, Yoo KD, Jeong CW, Kim HH, Min SI, et al. Long-term mortality risks among living kidney donors in Korea. Am J Kidney Dis. 2020;75(6):919–25.

    Article  PubMed  Google Scholar 

  28. Krishnan N, Mumford L, Lipkin G, Gill P, Fletcher S, Dasgupta I, et al. Comparison of medium-term outcomes of living kidney donors with longitudinal healthy control in the United Kingdom. Transplantation. 2020;104(3):e65–74.

    Article  PubMed  Google Scholar 

  29. Muzaale AD, Massie AB, Wang MC, Montgomery RA, McBride MA, Wainright JL, et al. Risk of end-stage kidney disease following live kidney donation. J Am Med Assoc. 2014;311(6):579–86.

    Article  CAS  Google Scholar 

  30. Matas AJ, Berglund DM, Vock DM, Ibrahim HN. Causes and timing of end-stage kidney disease after living kidney donation. Am J Transplant. 2018;18(5):1140–50.

    Article  PubMed  Google Scholar 

  31. Kido R, Shibagaki Y, Iwadoh K, Nakajima I, Fuchinoue S, Fujita T, et al. How do living kidney donors develop end-stage kidney disease? Am J Transplant. 2009;9(11):2514–9.

    Article  CAS  PubMed  Google Scholar 

  32. Sanchez OA, Ferrara LK, Rein S, Berglund D, Matas AJ, Ibrahim HN. Hypertension after kidney donation: incidence, predictors, and correlates. Am J Transplant. 2018;18(10):2534–43.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  33. Holscher CM, Haugen CE, Jackson KR, Garonzik Wang JM, Waldram MM, Bae S, et al. Self-reported incident hypertension and long-term kidney function in living kidney donors compared with healthy nondonors. Clin J Am Soc Nephrol. 2019;14(10):1493–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  34. Haugen AJ, Hallan S, Langberg NE, Dahle DO, Pihlstrøm H, Birkeland KI, et al. Increased long-term risk for hypertension in kidney donors—a retrospective cohort study. Transpl Int. 2020;33(5):536–43.

    Article  PubMed  Google Scholar 

  35. Boudville N, Prasad GVR, Knoll G, Muirhead N, Thiessen-Philbrook H, Yang RC, et al. Meta-analysis: risk for hypertension in living kidney donors. Ann Intern Med. 2006;145(3):185–96.

    Article  PubMed  Google Scholar 

  36. Kasiske BL, Anderson-Haag TL, Duprez DA, Kalil RS, Kimmel PL, Pesavento TE, et al. A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years. Kidney Int. 2020;98(1):168–75.

    Article  CAS  PubMed  Google Scholar 

  37. Garg AX, Muirhead N, Knoll G, Yang RC, Prasad GVR, Thiessen-Philbrook H, et al. Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression. Kidney Int. 2006;70(10):1801–10.

    Article  CAS  PubMed  Google Scholar 

  38. Garg AX, Nevis IF, McArthur E, Sontrop JM, Koval JJ, Lam NN, et al. Gestational hypertension and preeclampsia in living kidney donors. N Engl J Med. 2015;372(2):124–33.

    Article  CAS  PubMed  Google Scholar 

  39. Reisæter AV, Røislien J, Henriksen T, Irgens LM, Hartmann A. Pregnancy and birth after kidney donation: the Norwegian experience. Am J Transplant. 2009;9(4):820–4.

    Article  PubMed  Google Scholar 

  40. Ibrahim HN, Akkina SK, Leister E, Gillingham K, Cordner G, Guo H, et al. Pregnancy outcomes after kidney donation. Am J Transplant. 2009;9(4):825–34.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  41. Moody WE, Ferro CJ, Edwards NC, Chue CD, Lin ELS, Taylor RJ, et al. Cardiovascular effects of unilateral nephrectomy in living kidney donors. Hypertension. 2016;67(2):368–77.

    Article  CAS  PubMed  Google Scholar 

  42. Price AM, Moody WE, Stoll VM, Vijapurapu R, Hayer MK, Biasiolli L, et al. Cardiovascular effects of unilateral nephrectomy in living kidney donors at 5 years. Hypertension. 2021;77(4):1273–84.

    Article  CAS  PubMed  Google Scholar 

  43. Lam NN, McArthur E, Kim SJ, Prasad GVR, Lentine KL, Reese PP, et al. Gout after living kidney donation: a matched cohort study. Am J Kidney Dis. 2015;65(6):925–32.

    Article  PubMed  Google Scholar 

  44. Steiner RW. “Normal for now” or “at future risk”: a double standard for selecting young and older living kidney donors. Am J Transplant. 2010;10(4):737–41.

    Article  CAS  PubMed  Google Scholar 

  45. Steiner RW. The risks of living kidney donation. N Engl J Med. 2016;374:479–80.

    Article  CAS  PubMed  Google Scholar 

  46. Mjøen G, Maggiore U, Kessaris N, Kimenai D, Watschinger B, Mariat C, et al. Long-term risks after kidney donation: how do we inform potential donors? A survey from descartes and EKITA transplantation working groups. Nephrol Dial Transplant. 2021;36(9):1742–53.

    Article  PubMed  PubMed Central  Google Scholar 

  47. Steiner RW, Gert B. A technique for presenting risk and outcome data to potential living kidney transplant donors. Transplantation. 2001;71(8):1056–7.

    Article  CAS  PubMed  Google Scholar 

  48. Steiner RW. Addressing the ESKD risks of the young living kidney donor: putting “normal for now” into practice. Curr Transplant Rep. 2016;3(1):15–23.

    Article  Google Scholar 

  49. Steiner R. GFR-related risks for kidney donors are here to stay, but what are they? Am J Transplant. 2018;18(10):2612.

    Article  PubMed  Google Scholar 

  50. Mandelbrot DA, Reese PP, Garg N, Thomas CP, Rodrigue JR, Schinstock C, et al. KDOQI US commentary on the 2017 KDIGO clinical practice guideline on the evaluation and care of living kidney donors. Am J Kidney Dis. 2020;75(3):299–316.

    Article  CAS  PubMed  Google Scholar 

  51. Manas D, Burnapp L, Andrews PA. Summary of the British Transplantation Society UK guidelines for living donor liver transplantation. Transplantation. 2016;100:1184–90.

    Article  PubMed  Google Scholar 

  52. Gaillard F, Courbebaisse M, Kamar N, Rostaing L, Del Bello A, Girerd S, et al. The age-calibrated measured glomerular filtration rate improves living kidney donation selection process. Kidney Int. 2018;94(3):616–24.

    Article  PubMed  Google Scholar 

  53. Porrini E, Ruggenenti P, Luis-Lima S, Carrara F, Jiménez A, de Vries APJ, et al. Estimated GFR: time for a critical appraisal. Nat Rev Nephrol. 2019;15(3):177–90.

    Article  CAS  PubMed  Google Scholar 

  54. Steiner RW. A very different paradigm for living kidney donor risk. Am J Transplant. 2017;17(7):1701–2.

    Article  CAS  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Transplantation, Oslo University Hospital, Oslo, Norway

    Geir Mjøen & Trond Jenssen

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  1. Geir Mjøen
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  2. Trond Jenssen
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Correspondence to Geir Mjøen .

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Editors and Affiliations

  1. University Hospitals Birmingham, Birmingham, UK

    Adnan Sharif

  2. University Hospitals Birmingham, Birmingham, UK

    Graham Lipkin

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Mjøen, G., Jenssen, T. (2022). Long-Term Outcomes for Living Donors. In: Sharif, A., Lipkin, G. (eds) Living Kidney Donation. Springer, Cham. https://doi.org/10.1007/978-3-031-09520-7_15

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  • DOI: https://doi.org/10.1007/978-3-031-09520-7_15

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