Long-Term Risks of Kidney Living Donation

Review and Position Paper by the ERA-EDTA DESCARTES Working Group

Umberto Maggiore; Klemens Budde; Uwe Heemann; Luuk Hilbrands; Rainer Oberbauer; Gabriel C. Oniscu; Julio Pascual; Soren Schwartz Sorensen; Ondrej Viklicky; Daniel Abramowicz

Disclosures

Nephrol Dial Transplant. 2017;32(2):216-223. 

In This Article

Abstract and Introduction

Abstract

Two recent matched cohort studies from the USA and Norway published in 2014 have raised some concerns related to the long-term safety of kidney living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science and Care for Renal Transplantation in European States (DESCARTES) board members critically review the literature in an effort to summarize the current knowledge concerning long-term risks of kidney living donation to help physicians for decision-making purposes and for providing information to the prospective live donors. Long-term risk of end-stage renal disease (ESRD) can be partially foreseen by trying to identify donors at risk of developing 'de novo' kidney diseases during life post-donation and by predicting lifetime ESRD risk. However, lifetime risk may be difficult to assess in young donors, especially in those having first-degree relatives with ESRD. The study from Norway also found an increased risk of death after living donor nephrectomy, which became visible only after >15 years of post-donation follow-up. However, these findings are likely to be largely the result of an overestimation due to the confounding effect related to a family history of renal disease. DESCARTES board members emphasize the importance of optimal risk–benefit assessment and proper information to the prospective donor, which should also include recommendations on health-promoting behaviour post-donation.

Introduction

Kidney transplantation with living donor organs is associated with longer graft and patient survival compared with deceased donor organs. Until recently, we have been reassured by the fact that the long-term risk of end-stage renal disease (ESRD) or death in living kidney donors is similar to or even smaller than the general population.[1,2] However, because living donors are selected among the healthiest, their long-term outcomes should be better rather than equal to the general population. Two recent studies have tried to compare donors with healthy subjects rather than with the general population.[3,4] The findings of these studies have raised some concerns related to the long-term safety of living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science and Care for Renal Transplantation in European States (DESCARTES) board members critically reviewed the most recent literature concerning the long-term risk estimates of living donation. The present article represents an effort to summarize the current knowledge that may aid physicians in decision-making and in providing information to prospective live donors.

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