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Dayal C, Davies M, Diana NE, Meyers A. Living kidney donation in a developing country. PLoS One 2022; 17:e0268183. [PMID: 35536829 PMCID: PMC9089923 DOI: 10.1371/journal.pone.0268183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background
Living kidney donation has been advocated as a means to ameliorate the chronic shortage of organs for transplantation. Significant rates of comorbidity and familial risk for kidney disease may limit this approach in the local context; there is currently limited data describing living donation in Africa.
Methods
We assessed reasons for non-donation and outcomes following donation in a cohort of 1208 ethnically diverse potential living donors evaluated over a 32-year period at a single transplant centre in South Africa.
Results
Medical contraindications were the commonest reason for donor exclusion. Black donors were more frequently excluded (52.1% vs. 39.3%; p<0.001), particularly for medical contraindications (44% vs. 35%; p<0.001); 298 donors proceeded to donor nephrectomy (24.7%). Although no donor required kidney replacement therapy, an estimated glomerular filtration rate below 60 ml/min/1.73 m2 was recorded in 27% of donors at a median follow-up of 3.7 years, new onset albuminuria >300 mg/day was observed in 4%, and 12.8% developed new-onset hypertension. Black ethnicity was not associated with an increased risk of adverse post-donation outcomes.
Conclusion
This study highlights the difficulties of pursuing live donation in a population with significant medical comorbidity, but provides reassurance of the safety of the procedure in carefully selected donors in the developing world.
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Affiliation(s)
- Chandni Dayal
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Malcolm Davies
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nina Elisabeth Diana
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony Meyers
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
- National Kidney Foundation, Johannesburg, South Africa
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Lam NN, Lentine KL, Hemmelgarn B, Klarenbach S, Quinn RR, Lloyd A, Gourishankar S, Garg AX. Follow-up Care of Living Kidney Donors in Alberta, Canada. Can J Kidney Health Dis 2018; 5:2054358118789366. [PMID: 30083366 PMCID: PMC6073841 DOI: 10.1177/2054358118789366] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2018] [Accepted: 05/28/2018] [Indexed: 12/24/2022] Open
Abstract
Background Previous guidelines recommend that living kidney donors receive lifelong annual follow-up care to assess renal health. Objective To determine whether these best practice recommendations are currently being followed. Design Retrospective cohort study using linked health care databases. Setting Alberta, Canada (2002-2014). Patients Living kidney donors. Measurements We determined the proportion of donors who had annual outpatient physician visits and laboratory measurements for serum creatinine and albuminuria. Results There were 534 living kidney donors with a median follow-up of 7 years (maximum 13 years). The median age at the time of donation was 41 years and 62% were women. Overall, 25% of donors had all 3 markers of care (physician visit, serum creatinine, albuminuria measurement) in each year of follow-up. Adherence to physician visits was higher than serum creatinine or albuminuria measurements (67% vs 31% vs 28% of donors, respectively). Donors with guideline-concordant care were more likely to be older, reside closer to the transplant center, and receive their nephrectomy in more recent years. Limitations Our results may not be generalizable to other countries that do not have a similar universal health care system. Conclusions These findings suggest significant evidence-practice gaps, in that the majority of donors saw a physician, but the minority had measurements of kidney function or albuminuria. Future interventions should target improving follow-up care for all donors.
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Affiliation(s)
- Ngan N Lam
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Krista L Lentine
- Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, USA
| | - Brenda Hemmelgarn
- Department of Medicine, Division of Nephrology, University of Calgary, AB, Canada.,Departments of Medicine & Community Health Sciences, University of Calgary, AB, Canada
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Robert R Quinn
- Department of Medicine, Division of Nephrology, University of Calgary, AB, Canada.,Departments of Medicine & Community Health Sciences, University of Calgary, AB, Canada
| | - Anita Lloyd
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Sita Gourishankar
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Amit X Garg
- Department of Medicine, Division of Nephrology, Western University, London, ON, Canada.,Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada
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Expectations and Experiences of Follow-up and Self-Care After Living Kidney Donation: A Focus Group Study. Transplantation 2017; 101:2627-2635. [PMID: 28538499 DOI: 10.1097/tp.0000000000001771] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Ensuring donor wellbeing warrants ongoing monitoring after living kidney donation. However, there is considerable variability in donor follow-up processes, including information provided to donors regarding self-care. Loss to follow-up is common, suggesting that the aims and benefits of monitoring and follow-up may not be apparent. We aimed to describe the experiences and expectations of living kidney donors regarding follow-up and self-care after donation. METHODS Participants from 3 transplant centers in Australia and Canada participated in 14 focus groups (n = 123). Transcripts were analyzed thematically. RESULTS We identified 4 themes: lacking identification as a patient (invincibility and confidence in health, immediate return to normality, avoid burdening specialty services, redundancy of specialist attention, unnecessary travel), empowerment for health (self-preservation for devastating consequences, self-advocacy and education, needing lifestyle advice, tracking own results), safety net and reassurance (availability of psychosocial support, confidence in kidney-focused care, continuity and rapport, and access to waitlist priority), and neglect and inattention (unrecognized ongoing debilitations, primary focus on recipient, hospital abandonment, overlooking individual priorities, disconnected from system, coping with dual roles, and lacking support for financial consequences). CONCLUSIONS Living kidney donors who felt well and confident about their health regarded specialist follow-up as largely unnecessary. However, some felt they did not receive adequate medical attention, were prematurely detached from the health system, or held unresolved anxieties about the consequences of their decision to donate. Ongoing access to healthcare, psychosocial support, and education may reassure donors that any risks to their health are minimized.
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Lentine KL, Kasiske BL, Levey AS, Adams PL, Alberú J, Bakr MA, Gallon L, Garvey CA, Guleria S, Li PKT, Segev DL, Taler SJ, Tanabe K, Wright L, Zeier MG, Cheung M, Garg AX. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation 2017; 101:S1-S109. [PMID: 28742762 PMCID: PMC5540357 DOI: 10.1097/tp.0000000000001769] [Citation(s) in RCA: 194] [Impact Index Per Article: 27.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2017] [Accepted: 03/20/2017] [Indexed: 12/17/2022]
Abstract
The 2017 Kidney Disease: Improving Global Outcomes (KDIGO) Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors is intended to assist medical professionals who evaluate living kidney donor candidates and provide care before, during and after donation. The guideline development process followed the Grades of Recommendation Assessment, Development, and Evaluation (GRADE) approach and guideline recommendations are based on systematic reviews of relevant studies that included critical appraisal of the quality of the evidence and the strength of recommendations. However, many recommendations, for which there was no evidence or no systematic search for evidence was undertaken by the Evidence Review Team, were issued as ungraded expert opinion recommendations. The guideline work group concluded that a comprehensive approach to risk assessment should replace decisions based on assessments of single risk factors in isolation. Original data analyses were undertaken to produce a "proof-in-concept" risk-prediction model for kidney failure to support a framework for quantitative risk assessment in the donor candidate evaluation and defensible shared decision making. This framework is grounded in the simultaneous consideration of each candidate's profile of demographic and health characteristics. The processes and framework for the donor candidate evaluation are presented, along with recommendations for optimal care before, during, and after donation. Limitations of the evidence are discussed, especially regarding the lack of definitive prospective studies and clinical outcome trials. Suggestions for future research, including the need for continued refinement of long-term risk prediction and novel approaches to estimating donation-attributable risks, are also provided.In citing this document, the following format should be used: Kidney Disease: Improving Global Outcomes (KDIGO) Living Kidney Donor Work Group. KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Transplantation. 2017;101(Suppl 8S):S1-S109.
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Affiliation(s)
| | | | | | | | - Josefina Alberú
- Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | | | | | | | | | | | - Dorry L. Segev
- Johns Hopkins University, School of Medicine, Baltimore, MD
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Alejo JL, Luo X, Massie AB, Henderson ML, DiBrito SR, Locke JE, Purnell TS, Boyarsky BJ, Anjum S, Halpern SE, Segev DL. Patterns of primary care utilization before and after living kidney donation. Clin Transplant 2017; 31:10.1111/ctr.12992. [PMID: 28457016 PMCID: PMC5731477 DOI: 10.1111/ctr.12992] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/25/2017] [Indexed: 01/26/2023]
Abstract
BACKGROUND Annual visits with a primary care provider (PCP) are recommended for living kidney donors to monitor long-term health postdonation, yet adherence to this recommendation is unknown. METHODS We surveyed 1170 living donors from our center from 1970 to 2012 to ascertain frequency of PCP visits pre- and postdonation. Interviews occurred median (IQR) 6.6 (3.8-11.0) years post-transplant. We used multivariate logistic regression to examine associations between donor characteristics and PCP visit frequency. RESULTS Overall, only 18.6% had less-than-annual PCP follow-up postdonation. The strongest predictor of postdonation PCP visit frequency was predonation PCP visit frequency. Donors who had less-than-annual PCP visits before donation were substantially more likely to report less-than-annual PCP visits postdonation (OR=9.8 14.421.0, P<.001). Men were more likely to report less-than-annual PCP visits postdonation (adjusted OR=1.2 1.62.3, P<.01); this association was amplified in unmarried/noncohabiting men (aOR=2.4 3.96.3, P<.001). Donors without college education were also more likely to report less-than-annual PCP visits postdonation (aOR=1.3 1.82.5 , P=.001). CONCLUSIONS The importance of annual PCP visits should be emphasized to all living donors, especially those with less education, men (particularly single men), and donors who did not see their PCP annually before donation.
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Affiliation(s)
- Jennifer L Alejo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Xun Luo
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Macey L Henderson
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Sandra R DiBrito
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Jayme E Locke
- Department of Surgery, University of Alabama at Birmingham, Birmingham, AL, USA
| | - Tanjala S Purnell
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Brian J Boyarsky
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Saad Anjum
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Samantha E Halpern
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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Patient-Reported Outcomes Following Living Kidney Donation: A Single Center Experience. J Clin Psychol Med Settings 2016; 22:160-8. [PMID: 26123551 DOI: 10.1007/s10880-015-9424-9] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
This article describes the development and implementation of an initiative at one transplant center to annually assess psychosocial outcomes of living kidney donors. The current analysis focuses on a cohort of adults (n = 208) who donated a kidney at BIDMC between September 2005 and August 2012, in which two post-donation annual assessments could be examined. One and two year post-donation surveys were returned by 59 % (n = 123) and 47 % (n = 98) of LKDs, respectively. Those who did not complete any survey were more likely to be younger (p = 0.001), minority race/ethnicity (p < 0.001), and uninsured at the time of donation (p = 0.01) compared to those who returned at least one of the two annual surveys. The majority of donors reported no adverse physical or psychosocial consequences of donation, high satisfaction with the donation experience, and no donation decision regret. However, a sizable minority of donors felt more pain intensity than expected and recovery time was much slower than expected, and experienced a clinically significant decline in vitality. We describe how these outcomes are used to inform clinical practice at our transplant center as well as highlight challenges in donor surveillance over time.
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Lentine KL, Lam NN, Axelrod D, Schnitzler MA, Garg AX, Xiao H, Dzebisashvili N, Schold JD, Brennan DC, Randall H, King EA, Segev DL. Perioperative Complications After Living Kidney Donation: A National Study. Am J Transplant 2016; 16:1848-57. [PMID: 26700551 DOI: 10.1111/ajt.13687] [Citation(s) in RCA: 81] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2015] [Revised: 11/25/2015] [Accepted: 12/13/2015] [Indexed: 01/25/2023]
Abstract
We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14 964 living kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia-related injuries (2.4%), and "other" complications (6.6%). Major Clavien Classification of Surgical Complications grade IV or higher affected 2.5% of donors. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR 1.26, p = 0.001) and of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p < 0.0001), and grade IV or higher (aOR 1.56, p = 0.004) events. Other significant correlates of Clavien grade IV or higher events included obesity (aOR 1.55, p = 0.0005), predonation hematologic (aOR 2.78, p = 0.0002) and psychiatric (aOR 1.45, p = 0.04) conditions, and robotic nephrectomy (aOR 2.07, p = 0.002), while annual center volume >50 (aOR 0.55, p < 0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure, and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors.
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Affiliation(s)
- K L Lentine
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - N N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada
| | - D Axelrod
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - M A Schnitzler
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - A X Garg
- Division of Nephrology, Western University, London, Ontario, Canada
| | - H Xiao
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - N Dzebisashvili
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH
| | - J D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D C Brennan
- Transplant Nephrology, Washington University School of Medicine, St. Louis, MO
| | - H Randall
- Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO
| | - E A King
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
| | - D L Segev
- Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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