No Increase in Mortality for Living Kidney Donors

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At medium-term follow-up, there is no increase in the overall risk of death for Americans who become living kidney donors, concludes a study in the Journal of the American Medical Association.

The study included 80,347 people who became live kidney donors in the United States between 1994 and 2009, reported to the Organ Procurement and Transplantation Network through the United Network for Organ Sharing. Donors were followed up for a median of 6.3 years. Survival was compared with a cohort of 9364 matched participants from the third National Health and Nutrition Examination Survey (NHANES III), excluding those with contraindications to kidney donation.

The number of live kidney donors increased significantly over the years—in 2008, there were 5968 donors. The rate of death within 90 days after nephrectomy was 3.1 per 10,000 donors, and remained stable throughout the 15 years covered by the registry. This was so despite an increased number of donors over age 50. Surgical mortality was higher for men than women, 5.1 versus 1.7 per 10,000 donors; and for black donors than white donors, 7.6 versus 2.6 per 10,000. The strongest risk factor for mortality was hypertension: 36.7 versus 1.3 per 10,000 donors.

Despite the increase in 90-day mortality, live kidney donors had long-term mortality similar to or lower than that in the matched NHANES III cohort: at 12-year follow-up, mortality was 1.5 percent versus 2.9 percent, respectively. This remained so on stratification by age, sex, and race.

Living kidney donation is an increasingly important source of organs for transplantation. Although donation appears safe, continued follow-up is essential to gather accurate information on the expected outcomes.

This registry study finds no increase in mortality among living kidney donors at a median follow-up of 6.3 years, compared to a closely matched population cohort. Certain groups have increased surgical mortality; potential donors should be counseled accordingly. While calling for more research on the physiologic changes after nephrectomy, the authors conclude that living kidney donation is a “reasonable and safe” approach to increasing the number of kidneys for transplantation [Segev DL, et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010; 170:959–966].