Living Donor Outcomes in Kidney Trasnplantation

A major concern about living donors is the long-term impact of uninephrectomy on risk of hypertension, proteinuria, and chronic kidney disease. One of the more important recent reports regarding the long-term impact of living donation has been provided by Ibrahim and colleagues. This report described almost 3,700 kidney donors who donated kidneys over 44 years. At a mean of 12 years after donation, 85% of a subset of the living donors had a GFR of 60 ml/min or higher, 32.1% had hypertension, and 12.7% had albuminuria. Older age and a higher body mass index, but not a longer time since donation, were associated with both a lower GFR and hypertension. More time from donation was independently associated with albuminuria. Most importantly, the survival of kidney donors was similar to that of controls matched for age, gender, and ethnicity. ESRD developed in 11 donors, a rate of 180 cases per million persons per year, compared with a rate of 268 per million per year in the general population. Most donors had quality-of-life scores that were better than population norms, and the prevalence of coexisting conditions was similar to that among controls from the National Health and Nutrition Examination Survey (NHANES) who were matched for age, sex, race or ethnic
group, and BMI.

Ibrahim HN, Foley R, Tan L, Rogers T, Bailey RF, Guo H, Gross CR, Matas AJ: Long-term consequences of kidney donation. N Engl J Med 360: 459–469, 2009

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