New Data on Long-Term Outcomes in Living Kidney Donors

At mid- to long-term follow-up, living kidney donors are at significantly increased risk of end stage renal disease (ESRD) and preeclampsia, concludes a meta-analysis in the Annals of Internal Medicine.

A systematic review identified 52 observational studies comparing a broad range of health outcomes in living kidney donors, with follow-up of 1 to 24 years. Meta-analysis included 118,426 living kidney donors and 117,656 controls.

The data showed no significant difference in all-cause mortality for living kidney donors compared to nondonors. Several other outcomes of concern were also similar between groups, including cardiovascular disease, hypertension, and type 2 diabetes. Health-related quality of life scores, including physical and mental health components, were comparable as well. Some evidence suggested a higher vitality score in donors versus controls.

Living kidney donation was associated with higher mean diastolic blood pressure and lower mean estimated glomerular filtration rate. Living donors were more likely to develop ESRD: incidence rate 0.5 versus 0.1 per 1000 person-years, relative risk (RR) 8.8. Female donors were at increased risk for preeclampsia: incidence rate 5.9 versus 3.1 per 100 pregnancies, RR 2.12.

Questions remain as to the long-term impact of living kidney donation on donor health and well-being. The new meta-analysis, including data on nearly 120,000 living kidney donors, finds increased relative risks of ESRD and preeclampsia, although the absolute risks are low.

Overall mortality, cardiovascular disease and type 2 diabetes risk, and psychosocial outcomes are similar to those of nondonors. The authors discuss the implications for informing prospective donors of the risks of living kidney donation [O’Keefe LM, et al. Mid- and long-term health risks in living kidney donors: a systematic review and meta-analysis. Ann Intern Med 2018; DOI: 10.7326/M17-1235].

March 2018 (Vol. 10, Number 3)