1
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Rai N, Srivastava A, Singh SK, Dhayal IR, Kumar A, Sachdeva A. A Study of Quality of Life of Elderly Live Kidney Donors-An Interview-Based Prospective Follow-Up Study. Transplant Proc 2024; 56:1563-1568. [PMID: 39214722 DOI: 10.1016/j.transproceed.2024.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2024] [Revised: 07/14/2024] [Accepted: 07/30/2024] [Indexed: 09/04/2024]
Abstract
Quality of life (QoL) is a vital aspect of postdonation amongst donors, especially elderly donors. There is a limited study from India assessing the QoL amongst young live donors (YLD), and no study has been done on the elderly sub-group. This study was undertaken to determine the donors' sociodemographic and essential clinical characteristics, as well as to study the QoL of the live kidney donors and compare the QoL of elderly and young donors. Baseline demographic characters taken from the RTR registration register and SF-36 questionnaire were used to assess the QoL at baseline, discharge post-transplant, 1 month, 3 months, 6 months, and 12 months through an interview. We found that the QoL of the elderly donors in postkidney donation returns to baseline at the end of 6 months in all dimensions of the QoL amongst the North Indian population. The physical function is better amongst elderly donors at the end of 3 and 6 months than among young donors. The study's findings must be propagated to increase the donation of kidneys to older people. This is the first of its kind from India, necessitating further multicentric study.
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Affiliation(s)
- Nandan Rai
- Department of Urology and Renal Transplantation, Dr RMLIMS Lucknow, Uttar Pradesh, India
| | - Alok Srivastava
- Department of Urology and Renal Transplantation, Dr RMLIMS Lucknow, Uttar Pradesh, India.
| | - Sanjeet Kumar Singh
- Department of Urology and Renal Transplantation, Dr RMLIMS Lucknow, Uttar Pradesh, India
| | - Ishwar Ram Dhayal
- Department of Urology and Renal Transplantation, Dr RMLIMS Lucknow, Uttar Pradesh, India
| | - Ankit Kumar
- Department of Internal Medicine, Military Hospital Shimla, Shimla, Himanchal Pradesh, India
| | - Amit Sachdeva
- Department of Internal Medicine, Military Hospital Shimla, Shimla, Himanchal Pradesh, India; Department of Community Medicine, Indira Gandhi Medical college, Shimla, Himachal Pradesh, India
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2
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Massey EK, Rule AD, Matas AJ. Living Kidney Donation: A Narrative Review of Mid- and Long-term Psychosocial Outcomes. Transplantation 2024:00007890-990000000-00794. [PMID: 38886889 DOI: 10.1097/tp.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Living kidney donors make a significant contribution to alleviating the organ shortage. The aim of this article is to provide an overview of mid- and long-term (≥12 mo) living donor psychosocial outcomes and highlight areas that have been understudied and should be immediately addressed in both research and clinical practice. We conducted a narrative review by searching 3 databases. A total of 206 articles were included. Living donors can be divided into those who donate to an emotionally or genetically related person, the so-called directed donors, or to an emotionally or genetically unrelated recipient, the so-called nondirected donors. The most commonly investigated (bio)psychosocial outcome after living donation was health-related quality of life. Other generic (bio)psychological outcomes include specific aspects of mental health such as depression, and fatigue and pain. Social outcomes include financial and employment burdens and problems with insurance. Donation-specific psychosocial outcomes include regret, satisfaction, feelings of abandonment and unmet needs, and benefits of living kidney donation. The experience of living donation is complex and multifaceted, reflected in the co-occurrence of both benefits and burden after donation. Noticeably, no interventions have been developed to improve mid- or long-term psychosocial outcomes among living donors. We highlight areas for methodological improvement and identified 3 areas requiring immediate attention from the transplant community in both research and clinical care: (1) recognizing and providing care for the minority of donors who have poorer long-term psychosocial outcomes after donation, (2) minimizing donation-related financial burden, and (3) studying interventions to minimize long-term psychosocial problems.
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Affiliation(s)
- Emma K Massey
- Erasmus Medical Center Transplant Institute, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam, Zuid Holland, the Netherlands
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Arthur J Matas
- Department of Surgery, Transplantation Division, University of Minnesota, Minneapolis, MN
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3
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Alayoobi L, Aljenaidi HA, Alqassab W, Kaabi W, Alzeyedi H, Asiri A, Alhumaidan O, Aeknaifeth N, Jaradat A, El-Agroudy AE. Quality of Life in Kidney Donors: A Single-Center Experience. Cureus 2024; 16:e52481. [PMID: 38371011 PMCID: PMC10873901 DOI: 10.7759/cureus.52481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/17/2024] [Indexed: 02/20/2024] Open
Abstract
BACKGROUND Live kidney donation is used to treat end-stage renal disease, but it poses risks and decision-making challenges for donors. This study examines kidney donors' long-term quality of life (QOL). METHODS We conducted a cross-sectional survey on kidney donors between 1982 and 2018. We used the Short Form-36 (SF-36) (Arabic version) to measure the donors' QOL. Out of 60 donors contacted, 44 agreed to participate and responded. Demographic information, donor-recipient relationships, and specific questions about the donation were collected and analyzed. RESULTS The mean age of the donors was 50.1 ± 11.7 years at follow-up, and 26 (59.1%) were males. Most donors were siblings and parents, accounting for 36.4% (n=16) each. The time since the donation was 111.5 ± 97.1 months. All donors decided voluntarily to donate and all of them would do it again if given a chance. However, one donor (2.3%) complained that the donation had caused problems in his marriage, while six donors (13.4%) experienced clinically relevant distress, and two donors (4.5%) experienced financial disadvantages. Donors had high QOL scores, with a mean score of 73.1 and 96.9 (on a scale of 1-100) for the eight subscales. The highest score was for role social functioning, while the lowest was for energy/fatigue. The mean scores for the four fatigue subscales were low, ranging from 61.8 to 86.8. The lowest score was for feeling calm and reassured, while the highest was for feeling frustrated. In social functioning, the highest score was for the effect of mental health on work performance (97.2). We analyzed various demographic factors and their correlation with QOL and found no significant correlation in most domains regarding sociodemographic characteristics. CONCLUSIONS Our research indicates that most kidney donors have had a positive experience over the past four decades. Both male and female donors of all ages reported good long-term QOL, further enhanced by recognition and support from their families and friends. These findings provide further support for our current policy on organ donation.
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Affiliation(s)
| | | | | | - Waleed Kaabi
- Internal Medicine, Arabian Gulf University, Manama, BHR
| | | | | | | | | | - Ahmed Jaradat
- Family and Community Medicine, Arabian Gulf University, Manama, BHR
| | - Amgad E El-Agroudy
- Internal Medicine, Arabian Gulf University, Manama, BHR
- Nephrology, Urology & Nephrology Center, Mansoura University, Mansoura, EGY
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4
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Almeida M, Calheiros Cruz G, Sousa C, Figueiredo C, Ventura S, Silvano J, Pedroso S, Martins LS, Ramos M, Malheiro J. External Validation of the Toulouse-Rangueil Predictive Model to Estimate Donor Renal Function After Living Donor Nephrectomy. Transpl Int 2023; 36:11151. [PMID: 37008717 PMCID: PMC10065159 DOI: 10.3389/ti.2023.11151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/07/2023] [Indexed: 03/19/2023]
Abstract
A predictive model to estimate post-donation glomerular filtration rate (eGFR) and risk of CKD at 1-year was developed from a Toulouse-Rangueil cohort in 2017 and showed an excellent correlation to the observed 1-year post-donation eGFR. We retrospectively analyzed all living donor kidney transplants performed at a single center from 1998 to 2020. Observed eGFR using CKD-EPI formula at 1-year post-donation was compared to the predicted eGFR using the formula eGFR (CKD-EPI, mL/min/1.73 m2) = 31.71+ (0.521 × preoperative eGFR) − (0.314 × age). 333 donors were evaluated. A good correlation (Pearson r = 0.67; p < 0.001) and concordance (Bland-Altman plot with 95% limits of agreement −21.41–26.47 mL/min/1.73 m2; p < 0.001) between predicted and observed 1-year post-donation eGFR were observed. The area under the ROC curve showed a good discriminative ability of the formula in predicting observed CKD at 1-year post-donation (AUC = 0.83; 95% CI: 0.78–0.88; p < 0.001) with optimal cutoff corresponding to a predicted eGFR of 65.25 mL/min/1.73 m2 in which the sensibility and specificity to predict CKD were respectively 77% and 75%. The model was successfully validated in our cohort, a different European population. It represents a simple and accurate tool to assist in evaluating potential donors.
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Affiliation(s)
- Manuela Almeida
- Nephrology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
- *Correspondence: Manuela Almeida,
| | | | - Círia Sousa
- Centro Hospitalar de Trás os Montes e Alto Douro, Vila Real, Portugal
| | | | - Sofia Ventura
- Nephrology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - José Silvano
- Nephrology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Sofia Pedroso
- Nephrology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - La Salete Martins
- Nephrology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
| | - Miguel Ramos
- Departamento de Cirurgia, Centro Hospitalar Universitário do Porto, Porto, Portugal
| | - Jorge Malheiro
- Nephrology Department, Centro Hospitalar Universitário do Porto, Porto, Portugal
- Unit for Multidisciplinary Research in Biomedicine, Abel Salazar Institute of Biomedical Sciences, University of Porto, Porto, Portugal
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5
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Courtney AE, Moorlock G, Van Assche K, Burnapp L, Mamode N, Lennerling A, Dor FJMF. Living Donor Kidney Transplantation in Older Individuals: An Ethical Legal and Psychological Aspects of Transplantation (ELPAT) View. Transpl Int 2023; 36:11139. [PMID: 37152615 PMCID: PMC10161899 DOI: 10.3389/ti.2023.11139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2022] [Accepted: 04/12/2023] [Indexed: 05/09/2023]
Abstract
Living donor transplantation is the optimal treatment for suitable patients with end-stage kidney disease. There are particular advantages for older individuals in terms of elective surgery, timely transplantation, and early graft function. Yet, despite the superiority of living donor transplantation especially for this cohort, older patients are significantly less likely to access this treatment modality than younger age groups. However, given the changing population demographic in recent decades, there are increasing numbers of older but otherwise healthy individuals with kidney disease who could benefit from living donor transplantation. The complex reasons for this inequity of access are explored, including conscious and unconscious age-related bias by healthcare professionals, concerns relating to older living donors, ethical anxieties related to younger adults donating to aging patients, unwillingness of potential older recipients to consider living donation, and the relevant legislation. There is a legal and moral duty to consider the inequity of access to living donor transplantation, recognising both the potential disparity between chronological and physiological age in older patients, and benefits of this treatment for individuals as well as society.
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Affiliation(s)
- Aisling E. Courtney
- Regional Nephrology and Transplant Unit, Belfast City Hospital, Belfast, United Kingdom
- *Correspondence: Aisling E. Courtney,
| | - Greg Moorlock
- Warwick Medical School, University of Warwick, Coventry, United Kingdom
| | - Kristof Van Assche
- Research Group Personal Rights and Property Rights, University of Antwerp, Antwerp, Belgium
| | - Lisa Burnapp
- NHS Blood and Transplant, Bristol, United Kingdom
| | - Nizam Mamode
- Department of Surgery, King’s College London, London, United Kingdom
| | - Annette Lennerling
- The Transplant Centre, Sahlgrenska University Hospital, Gothenburg, Sweden
- Institute of Health and Care Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Frank J. M. F. Dor
- Imperial College Renal and Transplant Centre, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
- Department of Surgery and Cancer, Imperial College, London, United Kingdom
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6
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Benoit T, Prudhomme T, Adypagavane A, Malavaud B, Soulié M, Gamé X, Kamar N, Dariane C, Legendre C, Méjean A, Roumiguié M, Timsit MO. External Validation of a Predictive Model to Estimate Renal Function After Living Donor Nephrectomy. Transplantation 2021; 105:2445-2450. [PMID: 33496555 DOI: 10.1097/tp.0000000000003643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Transplantation from living donor nephrectomy (LDN) is the best treatment for end-stage renal disease but observed decrease in donor renal function is a major concern. The aim of this study was to externally validate a predictive model to estimate 1-y postdonation estimated glomerular filtration rate (eGFR) and risk of chronic kidney disease (CKD) in living donors. METHODS All LDN performed at Necker Hospital from January 2006 to May 2018 were retrospectively included. Observed eGFR (using CKD-EPI formula) at 1-y post LDN was compared with the predicted eGFR calculated with a formula developed at Toulouse-Rangueil and based on predonation eGFR and age. Pearson correlation, receiver operating characteristics curve (ROC curve), and calibration curve were used to assess external validity of the proposed prognostic model to predict postoperative eGFR and occurrence of CKD in donors. RESULTS Four hundred donors were evaluated with a mean postoperative eGFR of 62.1 ± 14 mL/min/1.73m2. Significant correlation (Pearson r = 0.66; P < 0.001) and concordance (Bradley-Blackwood F = 49.189; P < 0.001) were observed between predicted and observed 1-y eGFR. Area under the receiver operating characteristic curve of the model relevant accuracy was 0.86 (95% CI, 0.82-0.89). CONCLUSIONS This study externally validated the formula to predict 1-y postdonation eGFR. The calculator could be an accurate tool to improve the selection of living kidney donor candidate.
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Affiliation(s)
- Thibaut Benoit
- Department of Urology, Clinique Pasteur, Toulouse, France
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Aurélien Adypagavane
- Department of Urology and Renal Transplantation, Hôpital Necker and Hôpital européen Georges-Pompidou (HEGP), AP-HP, Paris, France
| | - Bernard Malavaud
- Department of Urology, Institut Universitaire du Cancer, Toulouse, France
| | - Michel Soulié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Xavier Gamé
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Nassim Kamar
- Université de Paris, PARCC, INSERM, Paris, France
| | - Charles Dariane
- Department of Urology and Renal Transplantation, Hôpital Necker and Hôpital européen Georges-Pompidou (HEGP), AP-HP, Paris, France
| | - Christophe Legendre
- Department of Nephrology and Organ Transplantation, Toulouse Rangueil University Hospital, Toulouse, France
| | - Arnaud Méjean
- Department of Urology and Renal Transplantation, Hôpital Necker and Hôpital européen Georges-Pompidou (HEGP), AP-HP, Paris, France
| | - Mathieu Roumiguié
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Marc Olivier Timsit
- Department of Urology and Renal Transplantation, Hôpital Necker and Hôpital européen Georges-Pompidou (HEGP), AP-HP, Paris, France
- Université de Paris, PARCC, INSERM, Paris, France
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7
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Menjivar A, Torres X, Manyalich M, Fehrman-Ekholm I, Papachristou C, de Sousa-Amorim E, Paredes D, Hiesse C, Yucetin L, Oppenheimer F, Kondi E, Peri JM, Kvarnström N, Ballesté C, Dias L, Frade IC, Lopes A, Diekmann F, Revuelta I. Psychosocial risk factors for impaired health-related quality of life in living kidney donors: results from the ELIPSY prospective study. Sci Rep 2020; 10:21343. [PMID: 33288792 PMCID: PMC7721886 DOI: 10.1038/s41598-020-78032-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Accepted: 11/06/2020] [Indexed: 01/10/2023] Open
Abstract
Living kidney donors' follow-up is usually focused on the assessment of the surgical and medical outcomes. Whilst the psychosocial follow-up is advocated in literature. It is still not entirely clear which exact psychosocial factors are related to a poor psychosocial outcome of donors. The aim of our study is to prospectively assess the donors' psychosocial risks factors to impaired health-related quality of life at 1-year post-donation and link their psychosocial profile before donation with their respective outcomes. The influence of the recipient's medical outcomes on their donor's psychosocial outcome was also examined. Sixty donors completed a battery of standardized psychometric instruments (quality of life, mental health, coping strategies, personality, socio-economic status), and ad hoc items regarding the donation process (e.g., motivations for donation, decision-making, risk assessment, and donor-recipient relationship). Donors' 1-year psychosocial follow-up was favorable and comparable with the general population. So far, cluster-analysis identified a subgroup of donors (28%) with a post-donation reduction of their health-related quality of life. This subgroup expressed comparatively to the rest, the need for more pre-donation information regarding surgery risks, and elevated fear of losing the recipient and commitment to stop their suffering.
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Affiliation(s)
- Ana Menjivar
- Medical School, University of Barcelona, Barcelona, Spain.,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain
| | - Xavier Torres
- Psychiatry and Clinical Psychology Service, Institut Clinic de Neurociencies, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Marti Manyalich
- Medical School, University of Barcelona, Barcelona, Spain.,Transplant Assessorial Unit, Medical Direction, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ingela Fehrman-Ekholm
- Karolinska Institutet, Transplantation Surgery, Karolinska University Hospital, Stockholm, Sweden
| | - Christina Papachristou
- Department for Internal Medicine and Psychosomatics, Charité, University Medicine, Berlin, Germany.,School of Psychology, Aristotle University of Thessaloniki, Thessaloníki, Greece
| | - Erika de Sousa-Amorim
- Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - David Paredes
- Medical School, University of Barcelona, Barcelona, Spain.,Donation and Transplant Coordination Section, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Christian Hiesse
- Service de Néphrologie et de Transplantation Rénale, Hôpital Foch, Suresnes Cedex, France
| | - Levent Yucetin
- Organ Transplant Coordination, Antalya Medical Park Hospital, Antalya, Turkey
| | - Federico Oppenheimer
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Entela Kondi
- Medical School, University of Barcelona, Barcelona, Spain.,Transplant Assessorial Unit, Medical Direction, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Josep Maria Peri
- Psychiatry and Clinical Psychology Service, Institut Clinic de Neurociencies, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Niclas Kvarnström
- Department of Transplantation, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Chloë Ballesté
- Medical School, University of Barcelona, Barcelona, Spain
| | - Leonidio Dias
- Nephrology and Transplant Departments, Hospital Geral de Santo António, Porto, Portugal
| | - Inês C Frade
- Liaison-Psychiatry and Health Psychology Unit, Hospital Geral de Santo António, Porto, Portugal
| | - Alice Lopes
- Liaison-Psychiatry and Health Psychology Unit, Hospital Geral de Santo António, Porto, Portugal
| | - Fritz Diekmann
- Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Ignacio Revuelta
- Medical School, University of Barcelona, Barcelona, Spain. .,Laboratori Experimental de Nefrologia I Trasplantament (LENIT), Institut d'Investigacions Biomediques August Pi i Sunyer (IDIBAPS), Barcelona, Spain. .,Department of Nephrology and Renal Transplant, Hospital Clinic of Barcelona, Barcelona, Spain.
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8
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Wahba R, Vitinius F, Walczuch B, Dieplinger G, Buchner D, Datta R, Lürssen N, Schlößer HA, Thomas M, Müller R, Kann M, Hellmich M, Kurschat C, Stippel DL. Hand-Assisted Retroperitoneoscopic Donor Nephrectomy Compared to Anterior Approach Open Donor Nephrectomy: Improved Long-Term Physical Component Score in Health-Related Quality of Life in Living Kidney Donors. Transplant Proc 2020; 53:786-792. [PMID: 32981693 DOI: 10.1016/j.transproceed.2020.08.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2020] [Revised: 07/03/2020] [Accepted: 08/08/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Health-related quality of life (HRQL), fatigue, anxiety, and depression are crucial for the living kidney donor (LKD). Follow-up data for HRQL of LKDs comparing surgical techniques, especially regarding hand-assisted retroperitoneoscopic donor nephrectomy (HARP), are sparse. The aim of this study was to evaluate the influence of abdominal wall trauma minimized by HARP in comparison to open anterior approach donor nephrectomy (AA) on HRQL and additional psychosocial aspects of LKDs during the long-term follow-up. MATERIAL AND METHODS This is a cross-sectional study comparing psychosocial aspects of LKD between HARP and AA. RESULTS This study included 100 LKDs (68 HARP, 28 AA, and 4 were excluded secondary to incomplete data). The time to follow-up was 22.6 ± 11.7 (HARP) vs 58.7 ± 13.9 (AA) months (P < .005). Complications ≥3a° due to Clavien-Dindo classification was 0% in both groups. There were higher scores in all physical aspects for HARP donors vs AA donors at that time (physical function: 89.8 ± 14.6 vs 80.0 ± 19.9, P = .008, and the physical component score: 53.9 ± 7.6 vs 48.6 ± 8.5, P = .006). One year later (follow-up time + 12 months), HRQL for HARP donors was still higher. Mental items showed no significant differences. HARP donors showed better physical scores compared to the age-matched nondonor population (AA donors had lower scores). Neither the Multidimensional Fatigue Inventory-20 (MFI-20) or the Hospital Anxiety and Depression Scale (HADS) showed any differences between the 2 groups. Fatigue scores were higher for HARP and for AA compared to the age-matched population. CONCLUSIONS LKDs undergoing HARP showed better physical performance as part of HRQL in the long-term follow-up.
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Affiliation(s)
- Roger Wahba
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany.
| | - Frank Vitinius
- Department of Psychosomatics and Psychotherapy, Transplant Center Cologne, University of Cologne, Cologne, Germany
| | - Bianca Walczuch
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Georg Dieplinger
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Denise Buchner
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Rabi Datta
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Nadine Lürssen
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Hans Anton Schlößer
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Michael Thomas
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
| | - Roman Müller
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Martin Kann
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Martin Hellmich
- Institute of Medical Statistics and Computational Biology, University of Cologne, Faculty of Medicine and University Hospital Cologne, Cologne, Germany
| | - Christine Kurschat
- Department II of Internal Medicine and Center for Molecular Medicine Cologne, University of Cologne, Faculty of Medicine and University Hospital of Cologne, Cologne, Germany
| | - Dirk L Stippel
- Department of General, Visceral, Cancer and Transplant Surgery, Transplant Center Cologne, University Hospital of Cologne, University of Cologne, Cologne, Germany
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9
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Brunotte M, Rademacher S, Weber J, Sucher E, Lederer A, Hau HM, Stolzenburg JU, Seehofer D, Sucher R. Robotic assisted nephrectomy for living kidney donation (RANLD) with use of multiple locking clips or ligatures for renal vascular closure. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:305. [PMID: 32355749 PMCID: PMC7186662 DOI: 10.21037/atm.2020.02.97] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Robotic assisted nephrectomy for living donation (RANLD) is a rapid emerging surgical technique competing for supremacy with totally laparoscopic and laparoscopic hand assisted techniques. Opinions about the safety of specific techniques of vascular closure in minimally invasive living kidney donation are heterogeneous and may be different for laparoscopic and robotic assisted surgical techniques. Methods We retrospectively analyzed perioperative and short-term outcomes of our first (n=40) RANLD performed with the da Vinci Si surgical platform. Vascular closure of renal vessels was performed by either double clipping or a combination of clips and non-transfixing suture ligatures. Results RANLD almost quintupled in our center for the observed time period. A total of n=21 (52.5%) left and n=19 (47.5%) right kidneys were procured. Renal vessel sealing with two locking clips was performed in 18 cases (45%) Both, clips and non-transfixing ligatures were used in 22 cases (55%). Mean donor age was 53.075±11.68 years (range, 28–70). The average total operative time was 150.75±27.30 min. Right donor nephrectomy (139±22 min) was performed significantly faster than left (160.95±27.93 min, P=0.01). Warm ischemia time was similar for both vascular sealing techniques and did not differ between left and right nephrectomies. No conversion was necessary. Clavien-Dindo Grade ≤IIIb complications occurred in (n=5) 12.5%. Grade IV and V complications did not develop. In particular no hemorrhage occurred using multiple locking clips or suture ligatures for renal vascular closure. Mortality was 0%. Thirteen kidneys (32.5%) were transplanted across the AB0 barrier. Conclusions RANLD is an emerging minimally invasive surgical technique which facilitates excellent perioperative and short-term outcomes also when using multiple locking clips or suture ligatures for renal vascular closure.
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Affiliation(s)
- Maximilian Brunotte
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Sebastian Rademacher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Justine Weber
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Elisabeth Sucher
- Department of Gastroenterology, Division of Hepatology, University Hospital of Leipzig, Leipzig, Germany
| | - Andri Lederer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | | | - Daniel Seehofer
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
| | - Robert Sucher
- Department of Visceral, Transplant, Thoracic and Vascular Surgery, University Hospital of Leipzig, Leipzig, Germany
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10
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Klop KWJ, Timman R, Busschbach JJ, Dols LFC, Dooper IM, Weimar W, Ijzermans JNM, Kok NFM. Multivariate Analysis of Health-related Quality of Life in Donors After Live Kidney Donation. Transplant Proc 2018; 50:42-47. [PMID: 29407329 DOI: 10.1016/j.transproceed.2017.10.019] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2017] [Accepted: 10/10/2017] [Indexed: 01/22/2023]
Abstract
BACKGROUND Live-kidney donation has a low mortality rate. Evidence suggests that live-kidney donors experience a quality of life (QoL) comparable to or even superior to that of the general population. There is limited information on factors associated with a decrease in QoL in particular for baseline factors, which would improve information to the donor, donor selection, and convalescence. METHODS QoL data on 501 live donors included in three prospective studies between 2001 and 2010 were used. The 36-item short form health survey (SF-36) was used to measure QoL up to 1 year after the procedure. Longitudinal effects on both the mental (MCS) and physical component scales (PCS) were analyzed with multilevel linear regression analyses. Baseline variables were age, gender, body mass index (BMI), pain, operation type, and comorbidity. Other covariates were loss of the graft, glomerular filtration rate, and recipient complications. RESULTS After 1 year we observed a small decrease in PCS (effect size = -0.24), whereas the MCS increased (effect size = 0.32). Both PCS and MCS were still well above the norm of the general Dutch population. Factors associated with a change in PCS were BMI (Cohen's d = -0.17 for 5 BMI points) and age (d = -0.13 for each 10 years older). CONCLUSIONS Overall, QoL after live-donor nephrectomy is excellent. A lowered PCS is related to age and body weight. Expectations towards a decreased postoperative QoL at 1 year are unjustified. However, one should keep in mind that older and obese donors may develop a reduced physical QoL after live-kidney donation.
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Affiliation(s)
- K W J Klop
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - R Timman
- Department of Psychiatry, Unit of Medical Psychology and Psychotherapy, University Medical Center, Rotterdam, The Netherlands.
| | - J J Busschbach
- Department of Psychiatry, Unit of Medical Psychology and Psychotherapy, University Medical Center, Rotterdam, The Netherlands
| | - L F C Dols
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - I M Dooper
- Department of Nephrology, Radboud University Nijmegen Medical Center, The Netherlands
| | - W Weimar
- Department of Internal Medicine, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J N M Ijzermans
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - N F M Kok
- Department of Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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11
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Lafranca JA, Spoon EQW, van de Wetering J, IJzermans JNM, Dor FJMF. Attitudes among transplant professionals regarding shifting paradigms in eligibility criteria for live kidney donation. PLoS One 2017; 12:e0181846. [PMID: 28732093 PMCID: PMC5521829 DOI: 10.1371/journal.pone.0181846] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 06/26/2017] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND The transplant community increasingly accepts extended criteria live kidney donors, however, great (geographical) differences are present in policies regarding the acceptance of these donors, and guidelines do not offer clarity. The aim of this survey was to reveal these differences and to get an insight in both centre policies as well as personal beliefs of transplant professionals. METHODS An online survey was sent to 1128 ESOT-members. Questions were included about several extended donor criteria; overweight/obesity, older age, vascular multiplicity, minors as donors and comorbidities; hypertension, impaired fasting glucose, kidney stones, malignancies and renal cysts. Comparisons were made between transplant centres of three regions in Europe and between Europe and other countries worldwide. RESULTS 331 questionnaires were completed by professionals from 55 countries. Significant differences exist between regions in Europe in acceptance of donors with several extended criteria. Median refusal rate for potential live donors is 15%. Furthermore, differences are seen regarding pre-operative work-up, both in specialists who perform screening as in preoperative imaging. CONCLUSIONS Remarkably, 23.4% of transplant professionals sometimes deviate from their centre policy, resulting in more or less comparable personal beliefs regarding extended criteria. Variety is seen, proving the need for a standardized approach in selection, preferably evidence based.
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Affiliation(s)
- Jeffrey A. Lafranca
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Emerentia Q. W. Spoon
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, division of Nephrology, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N. M. IJzermans
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J. M. F. Dor
- Department of Surgery, division of HPB and Transplant Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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12
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Janki S, Klop KWJ, Hagen SM, Terkivatan T, Betjes MGH, Tran TCK, Ijzermans JNM. Robotic surgery rapidly and successfully implemented in a high volume laparoscopic center on living kidney donation. Int J Med Robot 2016; 13. [PMID: 26987773 DOI: 10.1002/rcs.1743] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 01/13/2016] [Accepted: 02/08/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND It is important to minimize risks associated with live donor nephrectomy. In this study we evaluated the results of left-sided robot-assisted donor nephrectomies in comparison with standard techniques. METHODS Data on perioperative results, kidney function, and recipient and graft survival were collected. All left-sided laparoscopic and hand-assisted procedures were selected as control groups. RESULTS Fifty-nine robot-assisted procedures were performed by two surgeons. Operative time was significantly longer in the robot-assisted group compared with both control groups. However, it decreased significantly during procedures 40-59 compared with procedures 20-39 (P = 0.014) to median 172.5 (114.0-242.0) min. One conversion to the open approach occurred in the robot group due to a bleeding of the renal artery stump. No difference was found between all techniques at 3 months post-donation. CONCLUSION Left-sided robot-assisted donor nephrectomy is feasible with over time a significant decrease in operative time with good outcomes for donor and recipient. Copyright © 2016 John Wiley & Sons, Ltd.
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Affiliation(s)
- S Janki
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - K W J Klop
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - S M Hagen
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T Terkivatan
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - M G H Betjes
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - T C K Tran
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
| | - J N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, Rotterdam, The Netherlands
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13
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Shakya D, K C T. QUALITY OF LIFE OF KIDNEY DONORS RESIDING IN KATHMANDU VALLEY. J Ren Care 2016; 42:115-22. [PMID: 26909874 DOI: 10.1111/jorc.12151] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
BACKGROUND Transplantation is evolving as an efficient treatment modality in Nepal for the rising cases of kidney failure. As living donors are healthy people donating their organ for the benefit of the recipient, it is imperative to ensure their safety. OBJECTIVES To assess the quality of life (QOL) of kidney donors and to compare it with healthy references. METHODOLOGY Cross-sectional, comparative design was used to find out the QOL of 59 donors and 59 healthy references. Convenience sampling was used to approach donors and eligible donors were interviewed at their residences. These were compared with age- and sex-matched references. QOL was assessed using SF36v2. RESULT Male, educated and employed donors were found to have better QOL than their counterparts. The comparison of donors and references showed better scores in the donors' QOL with significant differences in general health, mental health and mental component score. CONCLUSION This study concludes that living kidney donation does not impair the QOL of the donors but in turn may improve their mental health. Hence, this study supports the practice of living-related kidney transplantation. IMPLICATIONS Besides providing baseline data about donors in Nepal, this study may guide health professionals in counselling potential donors and assisting patients and their families to make informed decisions regarding transplant. It can assist health care planners in making policies concerning transplant.
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Affiliation(s)
- Dayana Shakya
- BSc Nursing Programme, Kathmandu Medical College, Sinamangal, Kathmandu, Nepal
| | - Takma K C
- Department of Adult Health Nursing, Maharajgunj Nursing Campus, Institute of Medicine, Tribhuvan University, Kathmandu, Nepal
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14
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Janki S, Klop KWJ, Kimenai HJAN, van de Wetering J, Weimar W, Massey EK, Dehghan A, Rizopoulos D, Völzke H, Hofman A, Ijzermans JNM. LOng-term follow-up after liVE kidney donation (LOVE) study: a longitudinal comparison study protocol. BMC Nephrol 2016; 17:14. [PMID: 26830198 PMCID: PMC4736233 DOI: 10.1186/s12882-016-0227-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 01/22/2016] [Indexed: 12/20/2022] Open
Abstract
Background The benefits of live donor kidney transplantation must be balanced against the potential harm to the donor. Well-designed prospective studies are needed to study the long-term consequences of kidney donation. Methods The “LOng-term follow-up after liVE kidney donation” (LOVE) study is a single center longitudinal cohort study on long-term consequences after living kidney donation. We will study individuals who have donated a kidney from 1981 through 2010 in the Erasmus University Medical Center in Rotterdam, The Netherlands. In this time period, 1092 individuals donated a kidney and contact information is available for all individuals. Each participating donor will be matched (1:4) to non-donors derived from the population-based cohort studies of the Rotterdam Study and the Study of Health in Pomerania. Matching will be based on baseline age, gender, BMI, ethnicity, kidney function, blood pressure, pre-existing co-morbidity, smoking, the use of alcohol and highest education degree. Follow-up data is collected on kidney function, kidney-related comorbidity, mortality, quality of life and psychological outcomes in all participants. Discussion This study will provide evidence on the long-term consequences of live kidney donation for the donor compared to matched non-donors and evaluate the current donor eligibility criteria. Trial registration Dutch Trial Register NTR3795.
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Affiliation(s)
- Shiromani Janki
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Karel W J Klop
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Hendrikus J A N Kimenai
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Willem Weimar
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Emma K Massey
- Department of Internal Medicine, Division of Nephrology and Transplantation, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Abbas Dehghan
- Department of Epidemiology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Dimitris Rizopoulos
- Department of Biostatistics, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
| | - Henry Völzke
- Ernst Moritz Arndt University Greifswald, Institute for Community Medicine, Walther-Rathenau-Straße 48, D-17475, Greifswald, Germany.
| | - Albert Hofman
- Department of Epidemiology, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands. .,Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA.
| | - Jan N M Ijzermans
- Department of Surgery, Division of HPB and Transplant Surgery, Erasmus University Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
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15
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Meyer K, Wahl AK, Bjørk IT, Wisløff T, Hartmann A, Andersen MH. Long-term, self-reported health outcomes in kidney donors. BMC Nephrol 2016; 17:8. [PMID: 26754798 PMCID: PMC4709885 DOI: 10.1186/s12882-016-0221-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2015] [Accepted: 01/08/2016] [Indexed: 11/29/2022] Open
Abstract
Background The wide use of healthy persons as kidney donors calls for awareness of risks associated with donation. Live kidney donation may impair quality of life (QOL) and result in fatigue. Long-term data on these issues are generally lacking in the donor population. Thus we aimed to investigate long-term self-reported health outcomes in a nationwide donor cohort. Methods We assessed self-reported QOL, fatigue and psychosocial issues after donation in 217 donors representing 63 % of those who donated 8–12 years ago. QOL was measured using the generic Short Form-36 Health Survey (SF-36), fatigue using the Multidimensional Fatigue Inventory (MFI) and psychosocial issues using donor specific questions. For each of the 8 domains of SF-36 and the 5 domains of MFI, we performed generalized linear regression. Results Donors scored high on QOL with mean scores between 63.9 and 91.4 (scale 1–100) for the 8 subscales. Recognition from family and friends was associated with higher QOL scores in four domains. There were no significant gender differences. Fatigue scores were generally low. Females generally scored higher than males on all five dimensions of fatigue, although significantly only on two. Recipient still alive was associated with lower scores on mental fatigue. Regretting donors scored higher than average on all domains of fatigue. Recipient death, worries about own health and worsened relationship with the recipient influenced willingness to donate in retrospect. Donor age did not affect long-term health outcomes. Conclusions Eight till 12 years after donation QOL scores were generally high and improved with recogniton from family and friends. Fatigue was independent of donor age and more pronounced in females and in those who regretted donation.
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Affiliation(s)
- Käthe Meyer
- Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, 0424, Oslo, Norway. .,Department of Transplantation, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Astrid Klopstad Wahl
- Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Ida Torunn Bjørk
- Department of Nursing Science, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Torbjørn Wisløff
- Oslo Centre for Biostatistics and Epidemiology, Research Support Services, Oslo University Hospital, Oslo, Norway. .,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, Oslo, Norway.
| | - Anders Hartmann
- Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, 0424, Oslo, Norway. .,Department of Transplantation, Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
| | - Marit Helen Andersen
- Department of Transplantation Medicine, Division of Cancer, Surgery and Transplantation, Oslo University Hospital, Rikshospitalet, Postbox 4950 Nydalen, 0424, Oslo, Norway. .,Department of Health Sciences, Institute of Health and Society, University of Oslo, Oslo, Norway.
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16
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Sutherland AI, IJzermans JNM, Forsythe JLR, Dor FJMF. Kidney and liver transplantation in the elderly. Br J Surg 2015; 103:e62-72. [PMID: 26662845 DOI: 10.1002/bjs.10064] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Accepted: 10/27/2015] [Indexed: 12/14/2022]
Abstract
BACKGROUND Transplant surgery is facing a shortage of deceased donor organs. In response, the criteria for organ donation have been extended, and an increasing number of organs from older donors are being used. For recipients, the benefits of transplantation are great, and the growing ageing population has led to increasing numbers of elderly patients being accepted for transplantation. METHODS The literature was reviewed to investigate the impact of age of donors and recipients in abdominal organ transplantation, and to highlight aspects of the fine balance in donor and recipient selection and screening, as well as allocation policies fair to young and old alike. RESULTS Overall, kidney and liver transplantation from older deceased donors have good outcomes, but are not as good as those from younger donors. Careful donor selection based on risk indices, and potentially biomarkers, special allocation schemes to match elderly donors with elderly recipients, and vigorous recipient selection, allows good outcomes with increasing age of both donors and recipients. The results of live kidney donation have been excellent for donor and recipient, and there is a trend towards inclusion of older donors. Future strategies, including personalized immunosuppression for older recipients as well as machine preservation and reconditioning of donor organs, are promising ways to improve the outcome of transplantation between older donors and older recipients. CONCLUSION Kidney and liver transplantation in the elderly is a clinical reality. Outcomes are good, but can be optimized by using strategies that modify donor risk factors and recipient co-morbidities, and personalized approaches to organ allocation and immunosuppression.
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Affiliation(s)
- A I Sutherland
- Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands.,Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - J N M IJzermans
- Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
| | - J L R Forsythe
- Transplant Unit, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - F J M F Dor
- Division of Hepatopancreatobiliary and Transplant Surgery, Erasmus MC, University Medical Center, Rotterdam, The Netherlands
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17
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Rowe TA, Huded J, McElroy L, Ladner DP, Lindquist LA. The Evolution of Living Kidney Donation and Transplantation in Older Adults. J Am Geriatr Soc 2015; 63:2616-2620. [DOI: 10.1111/jgs.13832] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Affiliation(s)
- Theresa A. Rowe
- Division of General Internal Medicine and Geriatrics; Comprehensive Transplant Center; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Jill Huded
- Division of General Internal Medicine and Geriatrics; Comprehensive Transplant Center; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Lisa McElroy
- Northwestern University Transplant Outcomes Research Collaborative; Comprehensive Transplant Center; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Daniela P. Ladner
- Northwestern University Transplant Outcomes Research Collaborative; Comprehensive Transplant Center; Feinberg School of Medicine; Northwestern University; Chicago Illinois
| | - Lee A. Lindquist
- Division of General Internal Medicine and Geriatrics; Comprehensive Transplant Center; Feinberg School of Medicine; Northwestern University; Chicago Illinois
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18
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Wirken L, van Middendorp H, Hooghof CW, Rovers MM, Hoitsma AJ, Hilbrands LB, Evers AWM. The Course and Predictors of Health-Related Quality of Life in Living Kidney Donors: A Systematic Review and Meta-Analysis. Am J Transplant 2015; 15:3041-54. [PMID: 26414703 DOI: 10.1111/ajt.13453] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2014] [Revised: 07/05/2015] [Accepted: 07/06/2015] [Indexed: 01/25/2023]
Abstract
A better understanding of the course and risk factors for impaired long-term health-related quality of life (HRQoL; ie, physical, psychological, and social-relational functioning) after kidney donation might help clinicians improve the care of live kidney donors. This systematic review and meta-analysis summarizes prospective studies about the course and predictors of HRQoL in living kidney donors. Studies indicate that shortly after donation, donors have lower HRQoL, with minor to moderate changes in psychological and social-relational functioning and major changes in physical functioning. At 3-12 months after donation, HRQoL returned to baseline or was slightly reduced, particularly for fatigue, but scores were still comparable to general population norms. Results were mainly robust across surgery techniques. A limited number of studies examined risk factors for impaired HRQoL, with low psychological functioning before donation as the most consistent predictor. Based on these results, clinicians can inform potential donors that, on average, kidney donors have high long-term HRQoL; however, donors with low psychological functioning at baseline are those most at risk of impaired long-term HRQoL. Future studies should focus on other potentially relevant predictors of postdonation HRQoL, including donor eligibility criteria and donor-recipient relationships, to optimize screening and interventions for donors at risk.
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Affiliation(s)
- L Wirken
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - H van Middendorp
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
| | - C W Hooghof
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - M M Rovers
- Radboud Institute of Health Sciences, Radboud university medical center, Nijmegen, The Netherlands
| | - A J Hoitsma
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - L B Hilbrands
- Department of Nephrology, Radboud university medical center, Nijmegen, The Netherlands
| | - A W M Evers
- Leiden University, Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden, The Netherlands.,Department of Medical Psychology, Radboud university medical center, Nijmegen, The Netherlands
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19
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Benzing C, Hau HM, Kurtz G, Schmelzle M, Tautenhahn HM, Morgül MH, Wiltberger G, Broschewitz J, Atanasov G, Bachmann A, Bartels M. Long-term health-related quality of life of living kidney donors: a single-center experience. Qual Life Res 2015; 24:2833-42. [PMID: 26149394 DOI: 10.1007/s11136-015-1027-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Over the last few years, the evaluation of the health-related quality of life (HRQoL) of living kidney donors (LKD) has become of particular interest. The present study sought to evaluate the physical and mental HRQoL after kidney removal. The clinical and paraclinical course of these patients was examined, and the impact of preoperative donor evaluation, donor nephrectomy, and surgical recovery was evaluated. These data were compared with reference data of the general population. METHODS Between 1998 and 2010, 72 living kidney donations were performed at our institution. To assess the HRQoL, two questionnaires-the Short Form 36 (SF-36) and a special LKD questionnaire-were sent to all 72 living donors. The records of the follow-up examinations of all 72 donors were retrospectively analyzed in order to assess the clinical and paraclinical data after kidney donation. RESULTS Out of 72 donors, 55 (76.4 %) responded to the questionnaires. There was no change in systolic and diastolic blood pressure during the 7-year follow-up (p > 0.05). Mild proteinuria (>150 mg/l) was observed in six cases. Kidney donors had a higher HRQoL compared to the general population with mean values of the physical and mental summation scale (PCS and MCS, respectively) being 51.3 (SD = 7.6) and 50.6 (SD = 8.1). Peri- or postoperative complications were associated with lower values for physical function and physical component summary (PCS) (p < 0.05). DISCUSSION Living donor kidney transplantation appears to be safe for donors. The HRQoL is excellent. To ensure a positive outcome for donors, a good clinical evaluation of potential donors is essential.
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Affiliation(s)
- Christian Benzing
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Greta Kurtz
- Department of Anesthesiology and Critical Care, Hospital of Mühlacker, Hermann-Hesse-Straße 34, 75417, Mühlacker, Germany
| | - Moritz Schmelzle
- Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Hans-Michael Tautenhahn
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Mehmet Haluk Morgül
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Georg Wiltberger
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Johannes Broschewitz
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Georgi Atanasov
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anette Bachmann
- Section for Nephrology, Department of Endocrinology and Nephrology, University Hospital of Leipzig, Leipzig, Germany
| | - Michael Bartels
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
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20
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Hod T, Goldfarb-Rumyantzev AS. Clinical issues in renal transplantation in the elderly. Clin Transplant 2015; 29:167-75. [DOI: 10.1111/ctr.12481] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 12/27/2022]
Affiliation(s)
- Tammy Hod
- Center for Vascular Biology Research; Department of Medicine; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Division of Nephrology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
| | - Alexander S. Goldfarb-Rumyantzev
- Division of Nephrology; Beth Israel Deaconess Medical Center and Harvard Medical School; Boston MA USA
- Transplant Institute; Beth Israel Deaconess Medical Center; Boston MA USA
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21
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Trasplante renal de donante vivo: “una mirada global”. UROLOGÍA COLOMBIANA 2014. [DOI: 10.1016/s0120-789x(14)50058-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
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22
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Ahmadi AR, Lafranca JA, Claessens LA, Imamdi RMS, IJzermans JNM, Betjes MGH, Dor FJMF. Shifting paradigms in eligibility criteria for live kidney donation: a systematic review. Kidney Int 2014; 87:31-45. [PMID: 24786706 DOI: 10.1038/ki.2014.118] [Citation(s) in RCA: 60] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2013] [Revised: 02/06/2014] [Accepted: 02/20/2014] [Indexed: 12/11/2022]
Abstract
As the organ shortage increases, inherently the demand for donor kidneys continues to rise. Thus, live kidney donation is essential for increasing the donor pool. In order to create successful expansion, extended criteria live kidney donors should be considered. This review combines current guidelines with all available literature in this field, trying to seek and establish the optimal extended criteria. Comprehensive searches were carried out in major databases until November 2013 to search for articles regarding older age, overweight and obesity, hypertension, vascular anomalies/multiplicity, nulliparous women, and minors as donors. Of the 2079 articles found, 152 fell within the scope of the review. Five major guidelines were included and reviewed. Based on the literature search, live kidney donation in older donors (up to 70 years of age) seems to be safe as outcome is comparable to younger donors. Obese donors have comparable outcome to lean donors, in short- and mid-term follow-up. Since little literature is available proving the safety of donation of hypertensive donors, caution is advised. Vascular multiplicity poses no direct danger to the donor and women of childbearing age can be safely included as donors. Although outcome after donation in minors is shown to be comparable to adult donors, they should only be considered if no other options exist. We conclude that the analyzed factors above should not be considered as absolute contraindications for donation.
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Affiliation(s)
- Ali R Ahmadi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jeffrey A Lafranca
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Laura A Claessens
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Raoul M S Imamdi
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Jan N M IJzermans
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michiel G H Betjes
- Division of Nephrology, Department of Internal Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Frank J M F Dor
- Division of Transplant Surgery, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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23
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Rodrigue JR, Fleishman A, Vishnevsky T, Whiting J, Vella JP, Garrison K, Moore D, Kayler L, Baliga P, Chavin KD, Karp S, Mandelbrot DA. Development and validation of a questionnaire to assess fear of kidney failure following living donation. Transpl Int 2014; 27:570-5. [PMID: 24606048 DOI: 10.1111/tri.12299] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2013] [Revised: 01/26/2014] [Accepted: 03/03/2014] [Indexed: 11/30/2022]
Abstract
Living kidney donors (LKDs) may feel more anxious about kidney failure now that they have only one kidney and the security of a second kidney is gone. The aim of this cross-sectional study was to develop and empirically validate a self-report scale for assessing fear of kidney failure in former LKDs. Participants were 364 former LKDs within the past 10 years at five US transplant centers and 219 healthy nondonor controls recruited through Mechanical Turk who completed several questionnaires. Analyses revealed a unidimensional factor structure, excellent internal consistency (α = 0.88), and good convergent validity for the Fear of Kidney Failure questionnaire. Only 13% of former donors reported moderate to high fear of kidney failure. Nonwhite race (OR = 2.9, P = 0.01), genetic relationship with the recipient (OR = 2.46, P = 0.04), and low satisfaction with the donation experience (OR = 0.49, P = 0.002) were significant predictors of higher fear of kidney failure. We conclude that while mild anxiety about kidney failure is common, high anxiety about future renal failure among former LKDs is uncommon. The Fear of Kidney Failure questionnaire is reliable, valid, and easy to use in the clinical setting.
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Affiliation(s)
- James R Rodrigue
- Center for Transplant Outcomes and Quality Improvement, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA; Harvard Medical School, Boston, MA, USA
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