Accurate information about the effects of donor nephrectomy is important in counseling potential live kidney donors. Issues involve both the short-term risk – the risks of surgery and the immediate peri-operative period – and the long-term risks – overall health and specifically the function of the remaining kidney. Review of peri-operative mortality and long-term survival from registry data in over 80,000 live kidney donors from 1994 through 2009 revealed an overall 90 day mortality rate of 3.1 per 10,000 live donor nephrectomies. Surgical mortality was higher in men than women (5.1 vs. 1.7 per 10,000) and in African American/Hispanic compared with white donors (7.6 vs 2.6 per 10,000). Neither increased donor age, smoking, nor obesity (BMI > 30) was associated with higher surgical mortality. The long-term survival of living kidney donors was no different than that of age- and co-morbidity-matched National Health and Nutrition Examination Survey participants for all patients stratifies by age, sex, and race. Obesity is a common issue in potential live donors: a review of the OPTN database of over 5,000 live donors with known BMI data who donated over a 1.5 year period between July 2004 and December 2005 revealed that 40% were overweight, 17.8% were obese (BMI 30-35) and 4.7% were very obese (BMI >35). At baseline and at 6 month follow-up, higher BMI was associated with higher systolic BP, but changes in BP were similar across the groups. There were no apparent differences in decline in GFR or percent change in serum creatinine across these categories of obesity in 6 month follow-up. Others studies have shown that there is no greater decline in renal function in obese patients compared with non-obese patients. Lifetime risk of requiring renal replacement therapy after kidney donation is less than 1%.
Tavakol, MM, Vincenti, FG, Assadi, H, Frederick, MJ, Tomlanovich, SJ, Roberts, JP, Posselt, AM:
Long-term renal function and cardiovascular disease risk in obese kidney donors. Clin J Am Soc
Nephrol 4:1230-8, 2009
Nogueira, JM, Weir, MR, Jacobs, S, Breault, D, Klassen, D, Evans, DA, Bartlett, ST, Cooper, M: A study
of renal outcomes in obese living kidney donors. Transplantation 90:993-9, 2010
Reese, PP, Feldman, HI, Asch, DA, Thomasson, A, Shults, J, Bloom, RD: Short-term outcomes for
obese live kidney donors and their recipients. Transplantation 88:662-71, 2009
Axelrod, DA, McCullough, KP, Brewer, ED, Becker, BN, Segev, DL & Rao, PS: Kidney and pancreas
transplantation in the United States, 1999-2008: the changing face of living donation. Am J Transplant
10:987-1002, 2010
Davis, CL, Cooper, M: The state of U.S. living kidney donors. Clin J Am Soc Nephrol 5:1873-80, 2010
Segev, DL, Muzaale, AD, Caffo, BS, Mehta, SH, Singer, AL, Taranto, SE, McBride, MA, Montgomery,
RA: Perioperative mortality and long-term survival following live kidney donation. JAMA 303:959-66, 2010
Lentine, KL, Schnitzler, MA, Xiao, H, Saab, G, Salvalaggio, PR, Axelrod, D, Davis, CL, Abbott, KC,
Brennan, DC: Racial variation in medical outcomes among living kidney donors. N Engl J Med
363:724-32, 2010
Ardavan Mashhadian D.O.
Nephrologist
1400 S Grand Ave Suite 615, Los Angeles, CA 90015
(213) 537-0328
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