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Long-term monitoring of kidney donors may help prevent adverse events
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Constructing a national registry to improve long-term monitoring of living kidney donors — in a way that is similar to the continued care provided to recipients — could be valuable in preventing the likelihood of donors experiencing an adverse event, according to a recently published study.
“While organ donation will benefit the recipients, there are risks and lifelong implications for the living donors,” Jieming Chen, PhD, of the University of California, San Francisco, and colleagues wrote. “One of the most prominent gaps in our knowledge of living donation is our ability to visualize and understand the temporal trajectory of long-term post-donation outcomes for living donors. Transplant programs in the United States are required to follow up with the donors for only 2 years after transplant. There has been strong evidence to indicate that ailments can occur many years after donation, highlighting the need for more extensive and longer-term data.”
To explore long-term outcomes for donors while a nationwide registry is being established, researchers conducted a retrospective cohort study analyzing data from 9,558 living kidney donors (mean age, 39 years; 56.8% were women; 37.3% donated to siblings) from 20 clinical studies that took place between 1963 and 2016. Post-donation adverse events were considered, as well as eGFR trends before and after donation, and a trajectory map of post-donation ESRD and non-ESRD outcomes was constructed.
Researchers found 14.7% of living kidney donors had post-donation events (85.3% did not have recorded outcomes at all which, researchers said, could be due to a lack of follow-up). The most common post-donation events were cardiovascular or kidney-related conditions, including hypertension (8.4%), diabetes (2%), proteinuria (1.8%) and postoperative ileus (1.5%).
Furthermore, 56% of living kidney donors had eGFR decrease from healthy levels before donation to below 60 mL/min/1.73 m2 after donation, indicating moderate kidney disease.
Regarding the timing of events, researchers found 92.2% of surgery-related conditions occurred 2 years or earlier after transplant but that 90.2% of nonsurgical complications occurred 2 to 40 years after transplant.
Researchers also noted that living kidney donors often experience renal or cardiovascular events that increase the likelihood of renal failure without first experiencing intermediate events, which suggests that merely focusing on complications that arise shortly after donation may not help predict long-term renal function.
Finally, it was observed that women were more likely to be donors around the range of childbearing years (25 years). As kidney donation increases risks for hypertension and preeclampsia in pregnancies, these donors should be better informed and counseled, according to the researchers.
“Our post-donation outcome analyses strongly suggest that longer mandatory follow-up periods for living donors will help us understand the long-term effects and sequence of events after transplant,” the researchers wrote. “Overall, our work sets a blueprint for collection, analysis and open-source sharing of donor data and also highlights the importance of long-term follow-up of living donors.” – by Melissa J. Webb
Disclosures: Chen reports no relevant financial disclosures. Please see the study for all other authors’ relevant financial disclosures.
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