'Really Low' Risks for Living Kidney Donation, Says Surgeon

Nancy A. Melville

April 28, 2022

People who donate kidneys have a low risk of major complications, according to what is believed to be the largest study to date to examine the risks associated with living kidney donation via hand-assisted laparoscopic nephrectomy. 

"The results of this study are extremely reassuring for individuals who are considering being living kidney donors," coauthor Timucin Taner, MD, PhD, said in a press statement.

"We found that this lifesaving surgery, when performed at experienced transplant centers, is extremely safe," said Taner, chair of the Division of Transplant Surgery at Mayo Clinic's William J. von Liebig Center for Transplantation and Clinical Regeneration, in Rochester, Minnesota.

Almost 90,000 people in the United States are waiting for a kidney transplant, and patients who receive a kidney from a living donor generally have better outcomes because the kidney usually functions longer than an organ from a deceased donor.

"Living kidney donation is an incredibly generous act with great benefit to the recipient. However, living donation is not without risk to the donor," note Xiomara Benavides, MD, also of the Mayo Clinic, and colleagues, in the study, published in Mayo Clinic Proceedings.

Donors have expressed discontent that, in some instances, they had more debilitating and protracted recovery than they had been led to expect, they add, noting therefore that "a detailed understanding of these risks is essential to obtaining appropriate informed consent."

"I also believe that patients [kidney recipients] have legitimate concerns about potential [living] donors, [so] that is why we did the study, to show everyone that the surgical risks are really low," senior author Mark Stegall, MD, also of the Mayo Clinic, told Medscape Medical News.

Most Complications After Discharge

The surgeons retrospectively examined 3002 living kidney donor nephrectomies performed at the Mayo Clinic between January 1, 2000 and December 31, 2019.

The research was unusual in that the doctors examined results up to 120 days after the operation, whereas most other studies have only examined complications while in hospital or within the first 30 days post-transplant.

Indeed, they found that most complications occurred "after hospital discharge and thus may be underreported in the literature," suggesting "close follow-up is warranted."

Overall, 58% of the living donors were female and 87% were White. Donors were a mean age of 45 years, had a mean body mass index (BMI) of 27.7 kg/m2, and 30.3% had obesity (BMI ≥ 30 kg/m2).

There were no deaths related to surgery.

The overall complication rate was 12.4% (n = 371), 76% (n = 280) of which occurred up to 120 days after hospital discharge. Most were an infection or hernia related to the incision.

The incidence of major complications was 2.5% (n = 74). Of these, 15 were intraoperative, 12 were postoperative to discharge (seven were surgery-related complications requiring reoperation and five were medical complications), and 47 occurred after discharge to day 120 (all were reoperations, of which 46 were related to incisional issues).

"The overall rate of complications was somewhat lower than that reported in some larger national databases, which may reflect the higher experience with living donors at the Mayo Clinic," Stegall told Medscape Medical News.

"Most studies suggest that transplant programs that do a lot of these donor surgeries have lower complication rates — even in patients that might be viewed to have risk factors for complications [such as] obesity, smoking, prior surgery," he added. 

Paramedial Incisions Abandoned Early in the Study

Although no risk factors emerged for major complications, multivariate analysis showed risk factors for any complication included having had a paramedian incision (hazard ratio [HR], 2.54; P < .001); a history of abdominopelvic surgery (HR, 1.37; P = .01); male sex (HR, 1.37; P = .01); non-White race (HR, 1.40; P = .02), and early era of the experience.

"Early in the study, we perceived that a paramedian incision was leading to more complications, and we abandoned this approach in the early 2000s," the authors note.

The authors have reported no relevant financial relationships.

Mayo Clin Proc. Published online April 25, 2022. Full text

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