As donor nephrectomy is entirely performed for the beneficence of the recipient, minimizing surgical morbidity and preserving long-term mortality is a priority. Currently, laparoscopic nephrectomy is associated with less pain, shorter hospital stay and faster return to work, and a calculated mortality rate of 3.1 per 10,000 donors, controlled for age, race, and sex (1,2).
Does kidney donation, with its associated loss of glomerular mass, impart a risk profile similar to that of patients with chronic kidney disease (CKD)? Many studies have demonstrated no significant increase in mortality among donors in comparison to variably matched controls and variable follow-up times. In a larger study, Ibrahim et al. reported on the vital status of approximately 3700 kidney donors, matched for age, sex, race, and BMI over a 40-year time frame. In their analysis, there appeared to be no significant decrease in lifespan and in fact, the donors seemed to outlive their controls (3). Segev et al. demonstrated no significant change in overall survival among more than 80,000 kidney donors compared to age- and comorbidity-matched controls using national registry data (2). Studies in older donors demonstrate similar findings. Berger et al. demonstrated no significant increase in mortality among donors older than 70 years of age (4).
In general, kidney donors are in excellent health as they undergo extensive medical and surgical screening; however, the evidence suggests that reduced GFR may be an independent predictor of all-cause and cardiovascular mortality. Although GFR decline due to nephrectomy versus GFR decline in the setting of comorbid disease are mechanistically different, concerns regarding kidney donation and a possible increased cardiovascular risk remain. Mjoen et al. followed 2269 Norwegian donors for a median of 14.3 years and revealed that overall as well as cardiovascular mortality was lower in donors than the general population matched for age and gender (5). More recently, Garg et al. used extensive exclusion criteria to select for “the healthiest segment” of the general population for comparison with kidney donors. They were able to demonstrate no increased risk of death or cardiovascular event in kidney donors over a median follow-up of 6.5 years with maximum follow-up of 18 years (6).
Current literature suggests that donor outcomes are excellent and the appropriate screening of candidates may contribute to the decreased risk observed. Regardless, considerable interest remains in long-term outcomes among kidney donors as efforts are being made to expand the donor transplantation pool, including use of non-ideal donors. Creation of prospective studies of the less than ideal donors is crucial.
Yuan H, et al.. The safety and efficacy of laparoscopic donor nephrectomy for renal transplantation: An updated meta-analysis. Transplant Proc 2013; 45:65–76, 2013.
Segev DL, et al.. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010; 303:959–966.
Berger JC, et al.. Living kidney donors ages 70 and older: recipient and donor outcomes. Clin J Am Soc Nephrol 2011; 6:2887–2893.
Mjoen G, et al.. Overall and cardiovascular mortality in Norwegian kidney donors compared to the background population. Nephrol Dial Transplant 2012; 27:443–447.