Chapter 56
Evaluation of the Living Donor Kidney
Neil Boudville,
Amit X. Garg,
Neil Boudville
University of Western Australia, Medical School, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
Search for more papers by this authorAmit X. Garg
Western University, Institute for Clinical Evaluative Sciences Western Facility, Victoria Hospital, London, ON, Canada
Search for more papers by this authorNeil Boudville,
Amit X. Garg,
Neil Boudville
University of Western Australia, Medical School, Sir Charles Gairdner Hospital, Nedlands, WA, Australia
Search for more papers by this authorAmit X. Garg
Western University, Institute for Clinical Evaluative Sciences Western Facility, Victoria Hospital, London, ON, Canada
Search for more papers by this authorBook Editor(s):Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS,
Donald A. Molony MD,
Giovanni F.M. Strippoli MD, PhD, MPH, MM (Epi),
Jonathan C. Craig MBChB, DipCH, MMed(Clin Epi), PhD, FAHMS
Matthew Flinders Distinguished Professor Vice President and Executive Dean
College of Medicine and Public Health, Flinders University, Adelaide, Australia
Search for more papers by this authorDonald A. Molony MD
Professor of Medicine Distinguished Teaching Professor of the University of Texas System
Division of Renal Diseases and Hypertension AND Center for Clinical Research and Evidence-based Medicine, McGovern Medical School University of Texas, Houston, TX, USA
Search for more papers by this authorGiovanni F.M. Strippoli MD, PhD, MPH, MM (Epi)
Professor of Nephrology Adjunct Professor of Epidemiology
Department of Emergency and Organ Transplantation – University of Bari, Bari, Italy
School of Public Health, University of Sydney, Sydney, NSW, Australia
Search for more papers by this authorFirst published: 18 November 2022
Summary
This chapter discusses the assessment of a potential living kidney donor as this requires an appreciation of the existing literature on the risks involved with donation. An understanding of the risks involved with donating a kidney is a key component to obtaining fully informed consent from the donor prior to surgery. The kidneys are a key mediator of blood pressure control and so mechanistically it is easy to suspect that removal of one of two kidneys may lead to an increase in the patient's blood pressure. Hypertension in turn can lead to progression of chronic kidney disease and other adverse outcomes. Proteinuria in the general population is a predictor of renal outcomes, cardiovascular disease, and mortality. Traditionally, living kidney donors have not routinely been followed-up by kidney transplant units and are discharged back to their primary physician after postoperative recovery is assured.
References
- Rana , A. , Gruessner A , Agopian VG et al. ( 2015 ). Survival benefit of solid-organ transplant in the United States . JAMA Surg. 150 ( 3 ): 252 – 259 .
- ANZDATA Registry 40th Annual Report 2017 , Australia and New Zealand Dialysis and Transplant Registry. Adelaide, Australia (Data to 2016).
- Saran , R. , Robinson B , Abbott KC et al. ( 2018 ). US renal data system 2017 annual data report: epidemiology of kidney disease in the United States . Am. J. Kidney Dis. 71 ( 3S1 ): A7 .
- Glannon , W. ( 2018 ). The risk in living kidney donation . Cambridge Q. Healthcare Ethics 27 ( 1 ): 29 – 35 .
- Henderson , M.L. and Gross , J.A. ( 2017 ). Living organ donation and informed consent in the United States: strategies to improve the process . J. Law Med. Ethics 45 ( 1 ): 66 – 76 .
- Lentine , K.L. , Kasiske BL , Levey AS et al. ( 2017 ). KDIGO clinical practice guideline on the evaluation and care of living kidney donors . Transplantation 101 ( 8S Suppl 1 ): S1 – S109 .
- Segev , D.L. , Muzaale AD , Caffo BS et al. ( 2010 ). Perioperative mortality and long-term survival following live kidney donation . JAMA 303 ( 10 ): 959 – 966 .
- Lentine , K.L. and Patel , A. ( 2012 ). Risks and outcomes of living donation . Adv. Chronic Kidney Dis. 19 ( 4 ): 220 – 228 .
- Mjoen , G. , Oyen O , Holdaas H et al. ( 2009 ). Morbidity and mortality in 1022 consecutive living donor nephrectomies: benefits of a living donor registry . Transplantation 88 ( 11 ): 1273 – 1279 .
- Patel , S. , Cassuto J , Orloff M et al. ( 2008 ). Minimizing morbidity of organ donation: analysis of factors for perioperative complications after living-donor nephrectomy in the United States . Transplantation 85 ( 4 ): 561 – 565 .
- Schold , J.D. , Goldfarb DA , Buccini LD et al. ( 2013 ). Comorbidity burden and perioperative complications for living kidney donors in the United States . Clin. J. Am. Soc. Nephrol. 8 ( 10 ): 1773 – 1782 .
- Lentine , K.L. , Lam NN , Axelrod D et al. ( 2016 ). Perioperative complications after living kidney donation: a national study . Am. J. Transplant. 16 ( 6 ): 1848 – 1857 .
-
Garcia-Ochoa C
,
Feldman LS
,
Nguan C
,
Monroy-Cuadros M
,
Arnold J
,
Boudville N
,
Cuerden M
,
Dipchand C
,
Eng M
,
Gill J
,
Gourlay W
,
Karpinski M
,
Klarenbach S
,
Knoll G
,
Lentine KL
,
Lok CE
,
Luke P
,
Prasad GVR
,
Sener A
,
Sontrop JM
,
Storsley L
,
Treleaven D
,
Garg AX
;
Donor Nephrectomy Outcomes Research (DONOR) Network
.
Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study
.
Can J Kidney Health Dis.
2019
Jul 18;
6
:2054358119857718. doi: 10.1177/2054358119857718. PMID: 31367455; PMCID: PMC6643179.
10.1177/2054358119857718 Google Scholar
- Holbrook A , Schulman S , Witt DM , Vandvik PO , Fish J , Kovacs MJ , Svensson PJ , Veenstra DL , Crowther M , Guyatt GH . Evidence-based management of anticoagulant therapy: Antithrombotic Therapy and Prevention of Thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines . Chest. 2012 Feb; 141 ( 2 Suppl ): 7S – 47S .
- Housawi , A.A. , Young A , Boudville N et al. ( 2007 ). Transplant professionals vary in the long-term medical risks they communicate to potential living kidney donors: an international survey . Nephrol. Dial. Transplant. 22 ( 10 ): 3040 – 3045 .
- Young , J.H. , Klag MJ , Muntner P et al. ( 2002 ). Blood pressure and decline in kidney function: findings from the Systolic Hypertension in the Elderly Program (SHEP) . J. Am. Soc. Nephrol. 13 ( 11 ): 2776 – 2782 .
- Lentine , K.L. , Schnitzler MA , Xiao H et al. ( 2010 ). Racial variation in medical outcomes among living kidney donors . N. Engl. J. Med. 363 ( 8 ): 724 – 732 .
- Boudville , N. , Prasad GV , Knoll G et al. ( 2006 ). Meta-analysis: risk for hypertension in living kidney donors . Ann. Intern. Med. 145 ( 3 ): 185 – 196 .
- O'Keeffe , L.M. , Ramond A , Oliver-Williams C et al. ( 2018 ). Mid- and long-term health risks in living kidney donors: a systematic review and meta-analysis . Ann. Intern. Med. 168 ( 4 ): 276 – 284 .
- Chronic Kidney Disease Prognosis Consortium C , Matsushita K , van der Velde M , Astor BC et al. ( 2010 ). Association of estimated glomerular filtration rate and albuminuria with all-cause and cardiovascular mortality in general population cohorts: a collaborative meta-analysis . Lancet 375 ( 9731 ): 2073 – 2081 .
- Kasiske , B.L. Anderson-Haag T , Israni AK et al. ( 2015 ). A prospective controlled study of living kidney donors: three-year follow-up . Am. J. Kidney Dis. 66 ( 1 ): 114 – 124 .
- Ibrahim , H.N. , Foley R , Tan L et al. ( 2009 ). Long-term consequences of kidney donation . N. Eng. J. Med. 360 ( 5 ): 459 – 469 .
- Garg , A.X. , Muirhead N , Knoll G et al. ( 2006 ). Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression . Kidney Int. 70 ( 1810 ): 1801 – 1810 .
- Matsushita , K. , Selvin E , Bash LD et al. ( 2009 ). Change in estimated GFR associates with coronary heart disease and mortality . J. Am. Soc. Nephrol. 20 ( 12 ): 2617 – 2624 .
- Garg , A.X. , Meirambayeva A , Huang A et al. ( 2012 ). Cardiovascular disease in kidney donors: matched cohort study . BMJ 344 : e1203 .
- Mjoen , G. , Hallan S , Hartmann A et al. ( 2014 ). Long-term risks for kidney donors . Kidney Int. 86 ( 1 ): 162 – 167 .
- Rizvi , S.A. , Zafar MN , Jawad F et al. ( 2016 ). Long-term safety of living kidney donation in an emerging economy . Transplantation 100 ( 6 ): 1284 – 1293 .
- Fehrman-Ekholm , I. , Elinder CG , Stenbeck M et al. ( 1997 ). Kidney donors live longer . Transplantation 64 ( 7 ): 976 – 978 .
- Berger , J.C. , Muzaale AD , James N et al. ( 2011 ). Living kidney donors ages 70 and older: recipient and donor outcomes . Clin. J. Am. Soc. Nephrol. 6 ( 12 ): 2887 – 2893 .
- Muzaale , A.D. , Massie AB , Wang MC et al. ( 2014 ). Risk of end-stage renal disease following live kidney donation . JAMA 311 ( 6 ): 579 – 586 .
- Garg , A.X. , McArthur E , Lentine KL , et al. ( 2015 ). Gestational hypertension and preeclampsia in living kidney donors . N. Engl. J. Med. 372 ( 15 ): 1469 – 1470 .
- Reisaeter , A.V. , Roislien J , Henriksen T et al. ( 2009 ). Pregnancy and birth after kidney donation: the Norwegian experience . Am. J. Transplant. 9 ( 824 ): 820 – 824 .
- Ibrahim , H.N. , Akkina SK , Leister E et al. ( 2009 ). Pregnancy outcomes after kidney donation . Am. J. Transplant. 9 ( 4 ): 825 – 834 .
- Tong , A. , Chapman JR , Wong G et al. ( 2011 ). Screening and follow-up of living kidney donors: a systematic review of clinical practice guidelines . Transplantation 92 ( 9 ): 962 – 972 .
- Duerinckx , N. , Timmerman L , Van Gogh J et al. ( 2014 ). Predonation psychosocial evaluation of living kidney and liver donor candidates: a systematic literature review . Transpl. Int. 27 ( 1 ): 2 – 18 .
- Rodrigue , J.R. , Schold JD , Morrissey P et al. ( 2018 ). Mood, body image, fear of kidney failure, life satisfaction, and decisional stability following living kidney donation: findings from the KDOC study . Am. J. Transplant. 18 ( 6 ): 1397 – 1407 .
- Delmonico , F. and Council of the Transplantation Society ( 2005 ). A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines . Transplantation 79 ( 6 Suppl ): S53 – S66 .
- Cohney , S. , Kanellis J , Howell M . ( 2010 ). The CARI guidelines. Donor renal function . Nephrology (Carlton) 15 ( Suppl 1 ): S137 – S145 .
- Slinin , Y. , Brasure M , Eidman K et al. ( 2016 ). Long-term outcomes of living kidney donation . Transplantation 100 ( 6 ): 1371 – 1386 .
- Grams , M.E. , Sang YY , Levey AS et al. ( 2016 ). Kidney-failure risk projection for the living kidney-donor candidate . N. Engl. J. Med. 374 ( 5 ): 411 – 421 .
- Xiao , D. , Craig JC , Chapman JR et al. ( 2013 ). Donor cancer transmission in kidney transplantation: a systematic review . Am. J. Transplant. 13 ( 10 ): 2645 – 2652 .
- Nalesnik , M.A. , Woodle ES , DiMaio JM et al. ( 2011 ). Donor-transmitted malignancies in organ transplantation: assessment of clinical risk . Am. J. Transplant. 11 ( 6 ): 1140 – 1147 .
- Gupta G , Zhang Y , Carroll NV , Sterling RK . Cost-effectiveness of hepatitis C-positive donor kidney transplantation for hepatitis C-negative recipients with concomitant direct-acting antiviral therapy . Am J Transplant . 2018 ( 10 ): 2496 – 2505 .
- Levi , M.E. , Kumar D , Green M et al. ( 2014 ). Considerations for screening live kidney donors for endemic infections: a viewpoint on the UNOS policy . Am. J. Transplant. 14 ( 5 ): 1003 – 1011 .
- Clayton , P.A. , Saunders JR , McDonald SP et al. ( 2016 ). Risk-factor profile of living kidney donors: the Australia and New Zealand dialysis and transplant living kidney donor registry 2004-2012 . Transplantation 100 ( 6 ): 1278 – 1283 .
