Q&A: Living kidney donor surgery is safe, low risk for most patients
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Living kidney donor surgery is safe and low risk for most patients, according to a 20-year study conducted by the Mayo Clinic.
Further, a small percentage of donors experienced major complications and no patients died.
In a retrospective, single-center study, researchers evaluated 3,002 living kidney donors (58.6% were female; 87.1% were white; mean age was 45 years; 30.3% had a BMI of at least 30 kg/m2; 36.3 had a previous abdominopelvic surgery) who underwent hand-assisted laparoscopic living kidney donor nephrectomy from Jan. 1, 2000, to Dec. 31, 2019. Using medical records, researchers identified and categorized complications that occurred intraoperatively, before discharge and after discharge for up to 120 days after surgery.
Researchers used Clavien-Dindo (CD) classification to grade complications, considering CD grade III or higher as a major complication compared with CD grade I or II, which they considered as a minor complication.
Analyses revealed 12.4% of patients experienced post-surgical complications, most often being an infection or hernia related to the incision. No patients died due to the procedure and 76% of the complications occurred after discharge. Overall, 2.5% of patients experienced major complications and all recovered.
Healio interviewed Timucin Taner, MD, PhD, chair of the division of transplant surgery at Mayo Clinic’s William J. von Liebig Center for Transplantation and Clinical Regeneration in Minnesota, to further discuss the study findings.
Healio: What led your team to conduct this study?
Taner: As transplant surgeons and physicians, we observe that sometimes people don’t know the benefits of living donation. The benefits are mostly for the recipient because those who get a living donor kidney can avoid or limit their time on dialysis. So, we just wanted to highlight the fact that the surgical risk in this life-saving surgery is really low.
Healio: What makes this study stand out from others exploring the risk of living organ surgery?
Taner: This is the largest single-center study that looked into the complications of living kidney donation. We also looked at every single donor that was done, beginning from 2000 to the end of 2019. Those 20 years included over 3,000 donations.
Healio: Are there people who may still be at risk and should avoid becoming a living donor?
Taner: No. The study’s results are so reassuring that even if you did the surgery in people who are otherwise deemed a little higher risk based on other surgical studies (like people with obesity, prior surgeries, smoking history), even in those folks, we did not see any increased risk of complications with the surgery. Because of that, we are even more excited about the results of this study.
Healio: What impact do you think these results will have on the future of nephrology?
Taner: Hopefully, these results will convince potential donors who have heard about or read about surgical risks that the incidence of major complications is very low and most were experienced in the earlier era, but not in the later era in a large transplant center.
Healio: Do you think these results will impact living donor legislation?
Taner: I hope so. Because, compared to deceased donor kidney transplant, which has about an average of a 5-year waiting time in this country, living donation provides a timely transplant for a loved one from the donor. So, it makes sense. At any given time, there’s about 90,000 people in this country waiting for a kidney transplant. The deceased donor pool is not enough to transplant all those people.
Healio: You and your fellow researchers concluded that most complications occur after the discharge. Will you continue to follow up for long periods of time after surgery even though complications are unlikely?
Taner: Yes, we will. We owe it to donors to follow up, to make sure they don’t have any issues. We don’t just do the surgery and send them home, rather we follow them for many years to make sure they don’t have any complications directly related to the surgery. In the case that they do, that we can take care of those complications in a timely fashion. So, I hope this also convinces other centers that do these kinds of operations to follow the donors for a long period of time.
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