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Johnson JC, Venna R, Alzweri L. Analysis of sexual dysfunction development among male and female living kidney donors. Sex Med Rev 2024; 12:183-191. [PMID: 38364301 DOI: 10.1093/sxmrev/qeae003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Revised: 12/24/2023] [Accepted: 12/30/2023] [Indexed: 02/18/2024]
Abstract
INTRODUCTION Living kidney donations (LKDs) face a persistent demand for patients with end-stage renal disease, emphasizing the importance of LKDs' growth and success. Although living kidney donors generally exhibit excellent survival rates, little research has explored the development of long-term sexual dysfunction following LKD. OBJECTIVES This study aimed to analyze differences in 5-year sexual dysfunction outcomes between male and female living kidney donors, utilizing the TriNetX database, a federated network of electronic medical records from multiple U.S. healthcare organizations. METHODS A propensity score-matched cohort study compared 45-year sexual dysfunction outcomes in adult male and female living kidney donors from December 2013 to December 2022. Cohorts were matched on age; sex; race and ethnicity; diabetes, cardiovascular, genitourinary, and psychiatric comorbidities; lifestyle-related factors; and medications that may impact normal sexual functioning. Primary outcomes included hazard ratio (HR) for decreased libido, sexual dysfunction (composite of male erectile dysfunction, ejaculatory disorders, vaginismus/dyspareunia, infertility, orgasmic disorders, arousal/desire disorders), and sexually transmitted diseases. Secondary outcomes assessed sex counseling and interpersonal relationship issues with spouses or partners. RESULTS The matched cohorts included 2315 patients each (male, female), and the mean age was 42.3 ± 12.5 years. At 5 years, male donors had a significantly higher HR for sexual dysfunction (HR, 3.768; 95% confidence interval, 1.929-7.358). Erectile dysfunction occurred in 1% of male patients, while vaginismus/dyspareunia affected <1% of female patients. Other sexual disorders, decreased libido, sexually transmitted diseases, and incidences of sexual and interspousal counseling were not significantly different. CONCLUSION Male living kidney donors faced a higher risk of developing sexual dysfunction 5 years after donation. While LKD remains a safe and viable alternative, clinicians and donors should be mindful of the potential association with sexual dysfunction postdonation. Further research may enhance support for the well-being of living kidney donors.
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Affiliation(s)
- John C Johnson
- John Sealy School of Medicine, Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0655, United States
| | - Rahul Venna
- John Sealy School of Medicine, Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0655, United States
| | - Laith Alzweri
- John Sealy School of Medicine, Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0655, United States
- Division of Urology, Department of Surgery, University of Texas Medical Branch, Galveston, TX 77555-0655, United States
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Vital A, Siman-Tov M, Shlomai G, Davidov Y, Cohen-Hagai K, Shashar M, Askenasy E, Ghinea R, Mor E, Hod T. Assessing Health-Related Quality of Life in Non-Directed Versus Directed Kidney Donors: Implications for the Promotion of Non-Directed Donation. Transpl Int 2024; 37:12417. [PMID: 38283057 PMCID: PMC10811092 DOI: 10.3389/ti.2024.12417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 01/02/2024] [Indexed: 01/30/2024]
Abstract
Living kidney donation has increased significantly, but little is known about the post-donation health-related quality of life (HRQoL) of non-directed donors (NDs) vs. directed donors (DDs). We thus examined the outcomes of 112 living kidney donors (82 NDs, 30 DDs). For the primary outcomes-namely, the mean physical component summary (PCS) and mental component summary (MCS) scores of the 12-item Short Form Survey (SF-12) questionnaire-scores were significantly higher for the NDs vs. the DDs (PCS: +2.69, MCS: +4.43). For secondary outcomes, NDs had shorter hospital stays (3.4 vs. 4.4 days), returned to physical activity earlier (45 vs. 60 days), exercised more before and after donation, and continued physical activity post-donation. Regression analyses revealed that donor type and white blood cell count were predictive of the PCS-12 score, and donor type was predictive of the MCS-12 score. Non-directed donation was predictive of a shorter hospital stay (by 0.78 days, p < 0.001) and the odds of having PCS-12 and MCS-12 scores above 50 were almost 10 and 16 times higher for NDs, respectively (p < 0.05). These findings indicate the safety and potential benefits of promoting non-directed donation. However, careful selection processes must be maintained to prevent harm and exploitation.
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Affiliation(s)
- Assaf Vital
- Arrow Program for Medical Research Education, Sheba Medical Center, Tel-Hashomer, Israel
- Adelson School of Medicine, Ariel University, Ariel, Israel
| | - Maya Siman-Tov
- Department of Emergency and Disaster Management, School of Public Health, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Gadi Shlomai
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Internal Medicine D and Hypertension Unit, Division of Endocrinology, Diabetes and Metabolism, Sheba Medical Center, Tel-Hashomer, Israel
| | - Yana Davidov
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Liver Disease Center, Sheba Medical Center, Tel Hashomer, Israel
| | - Keren Cohen-Hagai
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Department of Nephrology and Hypertension, Meir Medical Center, Kfar Saba, Israel
| | - Moshe Shashar
- Department of Nephrology and Hypertension, Laniado Hospital, Netanya, Israel
| | - Enosh Askenasy
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Ronen Ghinea
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Eytan Mor
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
| | - Tammy Hod
- Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
- Renal Transplant Center, Sheba Medical Center, Tel-Hashomer, Israel
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Hwang CS, Kadakia Y, Sanchez-Vivaldi JA, Patel MS, Shah JA, DeGregorio L, Desai DM, Vagefi PA, MacConmara M. Delayed graft function in pediatric living donor kidney transplantation. Pediatr Transplant 2023; 27:e14432. [PMID: 36369617 DOI: 10.1111/petr.14432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/21/2022] [Accepted: 10/24/2022] [Indexed: 11/13/2022]
Abstract
BACKGROUND Pediatric recipients of living donor kidneys have a low rate of delayed graft function (DGF). We examined the incidence, risk factors and outcomes of DGF in pediatric patients who received a living donor allograft. METHODS The STARfile was queried to examine all pediatric patients transplanted with a living donor kidney between 2000 and 2020. Donor and recipient demographic data were examined, as were survival and outcomes. Recipients were stratified into DGF and no DGF groups. DGF was defined as the need for dialysis within the first week after transplant. RESULTS 6480 pediatric patients received a living donor (LD) kidney transplant during the study period. 269 (4.2%) developed DGF post-transplant. Donors were similar in age, creatinine, and cold ischemia time. Recipients of kidneys with DGF were similar in age, sensitization status and HLA mismatch. Focal segmental glomerulosclerosis (FSGS) was the most common diagnosis in recipients with DGF, and allograft thrombosis was the most common cause of graft loss in this group. Small recipients (weight < 15 kg) were found to have a significantly higher rate of DGF. Length of stay doubled in recipients with DGF, and rejection rates were higher post-transplant. Recipients of LD kidneys who developed DGF had significantly worse 1 year allograft survival (67% vs. 98%, p < .0001). CONCLUSIONS Pediatric living donor kidney transplant recipients who experience DGF have significantly poorer allograft survival. Optimizing the donor and recipient matching to avoid compounding risks may allow for better outcomes.
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Affiliation(s)
- Christine S Hwang
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
| | - Yash Kadakia
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Jorge A Sanchez-Vivaldi
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
| | - Madhukar S Patel
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
| | - Jigesh A Shah
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
| | - Lucia DeGregorio
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
| | - Dev M Desai
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
| | - Parsia A Vagefi
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
| | - Malcolm MacConmara
- Division of Surgical Transplantation, Department of Surgery, University Of Texas Southwestern Medical Center, Dallas, Texas, USA
- Division of Pediatric Transplantation, Children's Medical Center, Dallas, TX, USA
- TransMedics, Andover, MA, USA
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Hou Y, Kang F, Liu H, Yang C, Han M, Huang X, Guan X, Wang SM, Li J. Perioperative transcutaneous electrical acupoint stimulations as part of an enhanced recovery after surgery protocol for living donors undergoing nephrectomy: A randomized, controlled clinical trial. Heliyon 2023; 9:e14423. [PMID: 36950567 PMCID: PMC10025023 DOI: 10.1016/j.heliyon.2023.e14423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 02/22/2023] [Accepted: 03/04/2023] [Indexed: 03/24/2023] Open
Abstract
Objective Living kidney donors (LKDs) experience perioperative anxiety. We designed the following study to evaluate the anxiolytic effect of transcutaneous electrical acupoint stimulation (TEAS) during the perioperative period in a group of LKDs undergoing laparotomy nephrectomy. Methods LKDs were randomly assigned to either the TEAS or control group. Participants in the TEAS group received 30min of intervention (6-15 mA, 2-100 Hz), at Yintang (EX-HN-3), bilateral Taichong (LR3) and Neiguan (PC6) one day before surgery (D0), before induction of anesthesia (D1) and one day after surgery (D2). The participants in the control group received the same placement of electrodes but without electrical stimulation. Venous blood was collected before each intervention. Anxiety levels and recovery profiles were recorded. Results LKDs in the TEAS group had lower anxiety level than those in the control group at D1, D2 and three days after surgery (D3). The percentage differences were: 33.3%, 25.0%, and 22.2%; [95% confidence interval (CI), (-55.1%, -11.6%), (-47.4%, -2.6%), and (-42.3%, -2.2%); P = 0.005, P = 0.034, and P = 0.035; respectively]. LKDs who received TEAS had better sleep quality and short-term recovery profiles than those in the control group. The plasma levels of 5-hydroxytryptamine (5-HT) and melatonin (MT) in the TEAS group were significantly higher than those in the control group at D1 and D2 (5-HT: P = 0.001, and P < 0.001; MT: P = 0.006, and P = 0.001). At the 3-month follow up, fewer LKDs in the TEAS group had incisional pain when compared to the control group (P = 0.032). Conclusions Perioperative TEAS decreased perioperative anxiety and facilitated postoperative recovery in the LKDs, and potential decreased the development of chronic pain. Trial Registration: Registered at ChiCTR2000029891, http://www.chictr.org.cn/listbycreater.aspx.
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Affiliation(s)
- Yu Hou
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Fang Kang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Hongtao Liu
- Department of Kidney Transplantation, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Chengwei Yang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Mingming Han
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Xiang Huang
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Xiaohong Guan
- Department of Kidney Transplantation, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
| | - Shu-Ming Wang
- Department of Anesthesiology, University of Connecticut School of Medicine, Farmington, CT, USA
- Corresponding author.
| | - Juan Li
- Department of Anesthesiology, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, China
- Corresponding author.
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Kang E, Park S, Park J, Kim Y, Park M, Kim K, Kim HJ, Han M, Cho JH, Lee JP, Lee S, Kim SW, Park SM, Chae DW, Chin HJ, Kim YC, Kim YS, Choi I, Lee H. Long-term risk of all-cause mortality in live kidney donors: a matched cohort study. Kidney Res Clin Pract 2021; 41:102-113. [PMID: 34781640 PMCID: PMC8816409 DOI: 10.23876/j.krcp.21.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background Long-term outcomes of live kidney donors remain controversial, although this information is crucial for selecting potential donors. Thus, this study compared the long-term risk of all-cause mortality between live kidney donors and healthy control. Methods We performed a retrospective cohort study including donors from seven tertiary hospitals in South Korea. Persons who underwent voluntary health screening were included as controls. We created a matched control group considering age, sex, era, body mass index, baseline hypertension, diabetes, estimated glomerular filtration rate, and dipstick albuminuria. The study outcome was progression to end-stage kidney disease (ESKD), and all-cause mortality as identified in the linked claims database. Results We screened 1,878 kidney donors and 78,115 health screening examinees from 2003 to 2016. After matching, 1,701 persons remained in each group. The median age of the matched study subjects was 44 years, and 46.6% were male. Among the study subjects, 2.7% and 16.6% had underlying diabetes and hypertension, respectively. There were no ESKD events in the matched donor and control groups. There were 24 (1.4%) and 12 mortality cases (0.7%) in the matched donor and control groups, respectively. In the age-sex adjusted model, the risk for all-cause mortality was significantly higher in the donor group than in the control group. However, the significance was not retained after socioeconomic status was included as a covariate (adjusted hazard ratio, 1.82; 95% confidence interval, 0.87-3.80). Conclusion All-cause mortality was similar in live kidney donors and matched non-donor healthy controls with similar health status and socioeconomic status in the Korean population.
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Affiliation(s)
- Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Park
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jina Park
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Minsu Park
- Department of Statistics, Keimyung University, Daegu, Republic of Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo Jeong Kim
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Miyeun Han
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sik Lee
- Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Insun Choi
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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Suwelack B, Dugas M, Koch M, Sommerer C, Urban M, Gerß J, Wegner J, Burgmer M. [Safety of the Living Kidney Donor - The German National Register - Development and Structure of a National Register in the Health Service Research]. DAS GESUNDHEITSWESEN 2021; 83:S33-S38. [PMID: 34731891 DOI: 10.1055/a-1547-7114] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
The German living donor register Safety of the Living Kidney Donor - The German National Register (SOLKID-GNR) collects data of the medical and psychosocial outcome of living kidney donors. For the first time in Germany, a prospective data collection allows a scientifically based long-term analysis of how a living kidney donation influences the psychological and physical health of living kidney donors. This will contribute directly to improve the information and care of living kidney donors.
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Affiliation(s)
- Barbara Suwelack
- Medizinische Klinik D - Transplantationsnephrologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Martin Dugas
- Institut für Medizinische Informatik, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Martina Koch
- Klinik für Allgemein-, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Viszeral- und Transplantationschirurgie, Mainz, Deutschland
| | - Claudia Sommerer
- Nephrologie am Zentrum für Innere Medizin, UniversitätsKlinikum Heidelberg, Heidelberg, Deutschland
| | - Marc Urban
- Zentrum für Klinische Studien, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Joachim Gerß
- Institut für Biometrie und Klinische Forschung, Westfälische Wilhelms-Universität Münster, Münster, Deutschland
| | - Jeannine Wegner
- Medizinische Klinik D - Transplantationsnephrologie, Universitätsklinikum Münster, Münster, Deutschland
| | - Markus Burgmer
- Abteilung für Psychosomatische Medizin und Psychotherapie, LWL-Klinik Münster, Münster, Deutschland.,Klinik für Psychosomatik und Psychotherapie, Universitätsklinikum Münster, Münster, Deutschland
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Abstract
BACKGROUND Living kidney donors incur donation-related expenses, but how these expenses impact postdonation mental health is unknown. METHODS In this prospective cohort study, the association between mental health and donor-incurred expenses (both out-of-pocket costs and lost wages) was examined in 821 people who donated a kidney at one of the 12 transplant centers in Canada between 2009 and 2014. Mental health was measured by the RAND Short Form-36 Health Survey along with Beck Anxiety Inventory and Beck Depression Inventory. RESULTS A total of 209 donors (25%) reported expenses of >5500 Canadian dollars. Compared with donors who incurred lower expenses, those who incurred higher expenses demonstrated significantly worse mental health-related quality of life 3 months after donation, with a trend towards worse anxiety and depression, after controlling for predonation mental health-related quality of life and other risk factors for psychological distress. Between-group differences for donors with lower and higher expenses on these measures were no longer significant 12 months after donation. CONCLUSIONS Living kidney donor transplant programs should ensure that adequate psychosocial support is available to all donors who need it, based on known and unknown risk factors. Efforts to minimize donor-incurred expenses and to better support the mental well-being of donors need to continue. Further research is needed to investigate the effect of donor reimbursement programs, which mitigate donor expenses, on postdonation mental health.
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The Evolution of Living Donor Nephrectomy Program at A Hellenic Transplant Center. Laparoscopic vs. Open Donor Nephrectomy: Single-Center Experience. J Clin Med 2021; 10:jcm10061195. [PMID: 33809339 PMCID: PMC8001196 DOI: 10.3390/jcm10061195] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Revised: 02/27/2021] [Accepted: 03/05/2021] [Indexed: 01/11/2023] Open
Abstract
Since its introduction in 1995, laparoscopic nephrectomy has emerged as the preferred surgical approach for living donor nephrectomy. Given the ubiquity of the surgical procedure and the need for favorable outcomes, as it is an elective operation on otherwise healthy individuals, it is imperative to ensure appropriate preoperative risk stratification and anticipate intraoperative challenges. The aim of the present study was to compare peri-and postoperative outcomes of living kidney donors (LD), who had undergone laparoscopic nephrectomy (LDN), with a control group of those who had undergone open nephrectomy (ODN). Health-related quality of life (QoL) was also assessed using the validated SF-36 questionnaire. Data from 252 LD from a single transplant center from March 2015 to December 2020 were analyzed retrospectively. In total, 117 donors in the LDN and 135 in the ODN groups were assessed. Demographics, type of transplantation, BMI, duration of surgery, length of hospital stay, peri- and postoperative complications, renal function at discharge and QoL were recorded and compared between the two groups using Stata 13.0 software. There was no difference in baseline characteristics, nor in the prevalence of peri-and postoperative complications, with a total complication rate of 16% (mostly minor, Clavien–Dindo grade II) in both groups, while a different pattern of surgical complications was noticed between them. Duration of surgery was significantly longer in the ODN group (median 240 min vs. 160 min in LDN, p < 0.01), warm ischemia time was longer in the LDN group (median 6 min vs.2 min in ODN, p < 0.01) and length of hospital stay shorter in the LDN group (median 3 days vs. 7 days in ODN). Conversion rate from laparoscopic to open surgery was 2.5%. There was a drop in estimated glomerular filtration rate (eGFR) at discharge of 36 mL/min in the LDN and 32 mL/min in the ODN groups, respectively (p = 0.03). No death, readmission or reoperation were recorded. There was a significant difference in favor of LDN group for each one of the eight items of the questionnaire (SF1–SF8). As for the two summary scores, while the total physical component summary (PCS) score was comparable between the two groups (57.87 in the LDN group and 57.07 in the ODN group), the mental component summary (MCS) score was significantly higher (62.14 vs. 45.22, p < 0.001) in the LDN group. This study provides evidence that minimally invasive surgery can be performed safely, with very good short-term outcomes, providing several benefits for the living kidney donor, thereby contributing to expanding the living donor pool, which is essential, especially in countries with deceased-donor organ shortage.
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9
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Tomer N, Small A, Mirza O, Palese M. Evidence of Resilience in Kidney Donors: A New York Statewide Cohort Analysis. Transplant Proc 2021; 53:803-807. [PMID: 33551185 DOI: 10.1016/j.transproceed.2021.01.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 12/08/2020] [Accepted: 01/08/2021] [Indexed: 10/22/2022]
Abstract
INTRODUCTION Donor nephrectomy (DN) is a procedure performed to provide recipients with a kidney to treat end-stage renal disease. The following analysis evaluated depression diagnosis in DN patients compared to controls. METHODS DN patients and matched controls were identified between 2000 and 2009 from the Statewide Planning and Research Cooperative System database. Cohorts were tracked for depression incidence. Multivariable logistic regression was used to determine independent predictors of a postoperative depression diagnosis. RESULTS The total study cohort included 2108 DN cases and 2108 controls. In both donors and controls, the baseline rate of depression was 0.95% (n = 20). The 5-year incidence of depression diagnosis after exposure increased in both cohorts (donors: 2.5%, n = 53; controls: 7.2%, n = 152; P < .001). The 5-year relative risk for developing depression was 2.65 (CI 1.59-4.42, P = .0002) in donors and 7.60 (CI 4.79-12.07, P < .001) in controls. On multivariable regression, being a donor was associated with reduced risk of developing postoperative depression (OR = 0.322, CI 0.233-0.445, P < .001), and the greatest risk factor for postoperative depression was a prior depressive diagnosis (OR = 7.811, CI 3.814-15.997, P < .001). CONCLUSION Our analysis shows that the strongest risk factor for depression was a prior diagnosis of depression. However, willingness to undergo donor nephrectomy is associated with less subsequent depression than the control population, suggesting that kidney donors may be a more resilient cohort.
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Affiliation(s)
- Nir Tomer
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Alexander Small
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Omar Mirza
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Michael Palese
- Department of Urology, Icahn School of Medicine at Mount Sinai, New York, NY.
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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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11
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Altruistic Renal Donation in a Patient With Dissociative Identity Disorder: A Case Report. PSYCHOSOMATICS 2020; 61:825-829. [DOI: 10.1016/j.psym.2020.01.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Revised: 01/07/2020] [Accepted: 01/08/2020] [Indexed: 12/25/2022]
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12
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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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13
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Lam NN, Dipchand C, Fortin MC, Foster BJ, Ghanekar A, Houde I, Kiberd B, Klarenbach S, Knoll GA, Landsberg D, Luke PP, Mainra R, Singh SK, Storsley L, Gill J. Canadian Society of Transplantation and Canadian Society of Nephrology Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Can J Kidney Health Dis 2020; 7:2054358120918457. [PMID: 32577294 PMCID: PMC7288834 DOI: 10.1177/2054358120918457] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2020] [Accepted: 02/25/2020] [Indexed: 12/15/2022] Open
Abstract
Purpose of review: To review an international guideline on the evaluation and care of living
kidney donors and provide a commentary on the applicability of the
recommendations to the Canadian donor population. Sources of information: We reviewed the 2017 Kidney Disease: Improving Global Outcomes (KDIGO)
Clinical Practice Guideline on the Evaluation and Care of Living Kidney
Donors and compared this guideline to the Canadian 2014 Kidney Paired
Donation (KPD) Protocol for Participating Donors. Methods: A working group was formed consisting of members from the Canadian Society of
Transplantation and the Canadian Society of Nephrology. Members were
selected to have representation from across Canada and in various
subspecialties related to living kidney donation, including nephrology,
surgery, transplantation, pediatrics, and ethics. Key findings: Many of the KDIGO Guideline recommendations align with the KPD Protocol
recommendations. Canadian researchers have contributed to much of the
evidence on donor evaluation and outcomes used to support the KDIGO
Guideline recommendations. Limitations: Certain outcomes and risk assessment tools have yet to be validated in the
Canadian donor population. Implications: Living kidney donors should be counseled on the risks of postdonation
outcomes given recent evidence, understanding the limitations of the
literature with respect to its generalizability to the Canadian donor
population.
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Affiliation(s)
- Ngan N Lam
- Division of Nephrology, University of Calgary, AB, Canada
| | | | | | - Bethany J Foster
- Division of Pediatric Nephrology, McGill University, Montréal, QC, Canada
| | - Anand Ghanekar
- Department of Surgery, University of Toronto, ON, Canada
| | - Isabelle Houde
- Division of Nephrology, Centre Hospitalier de l'Université de Québec, Québec City, Canada
| | - Bryce Kiberd
- Division of Nephrology, Dalhousie University, Halifax, NS, Canada
| | | | - Greg A Knoll
- Division of Nephrology, University of Ottawa, ON, Canada
| | - David Landsberg
- Division of Nephrology, University of British Columbia, Vancouver, Canada
| | - Patrick P Luke
- Division of Urology, Western University, London, ON, Canada
| | - Rahul Mainra
- Division of Nephrology, University of Saskatchewan, Saskatoon, Canada
| | - Sunita K Singh
- Division of Nephrology, University of Toronto, ON, Canada
| | - Leroy Storsley
- Section of Nephrology, University of Manitoba, Winnipeg, Canada
| | - Jagbir Gill
- Division of Nephrology, University of British Columbia, Vancouver, Canada
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14
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Wirken L, van Middendorp H, Hooghof CW, Sanders JSF, Dam RE, van der Pant KAMI, Wierdsma JM, Wellink H, van Duijnhoven EM, Hoitsma AJ, Hilbrands LB, Evers AWM. Psychosocial consequences of living kidney donation: a prospective multicentre study on health-related quality of life, donor-recipient relationships and regret. Nephrol Dial Transplant 2020; 34:1045-1055. [PMID: 30544241 DOI: 10.1093/ndt/gfy307] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Previous studies have indicated decreased health-related quality of life (HRQoL) shortly after kidney donation, returning to baseline in the longer term. However, a subgroup of donors experiences persistent HRQoL problems. To identify which HRQoL aspects are impacted most by the donation and to identify at-risk donors, more specific insight into psychosocial donation consequences is needed. METHODS The current study examined the HRQoL course, donor-perceived consequences of donation for donors, recipients and donor-recipient relationships, and regret up to 12 months post-donation in donors from seven Dutch transplantation centres. Kidney donor candidates (n = 588) completed self-report questionnaires early in the screening procedure, of which 361 (61%) donated their kidney. RESULTS Data for 230 donors (64%) with complete assessments before donation and 6 and 12 months post-donation were analysed. Results indicated that donor physical HRQoL was comparable at all time points, except for an increase in fatigue that lasted up to 12 months post-donation. Mental HRQoL decreased at 6 months post-donation, but returned to baseline at 12 months. Donors reported large improvements in recipient's functioning and a smaller influence of the recipient's kidney disease or transplantation on the donor's life over time. A subgroup experienced negative donation consequences with 14% experiencing regret 12 months post-donation. Predictors of regret were more negative health perceptions and worse social functioning 6 months post-donation. The strongest baseline predictors of higher fatigue levels after donation were more pre-donation fatigue, worse general physical functioning and a younger age. CONCLUSIONS Future research should examine predictors of HRQoL after donation to improve screening and to provide potential interventions in at-risk donors.
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Affiliation(s)
- Lieke Wirken
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Henriët van Middendorp
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Christina W Hooghof
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Jan-Stephan F Sanders
- Division of Nephrology, Department of Internal Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Ruth E Dam
- Department of Nephrology, Leiden University Medical Center, Leiden, The Netherlands
| | - Karlijn A M I van der Pant
- Division of Nephrology, Department of Internal Medicine, Renal Transplant Unit, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Judith M Wierdsma
- Department of Nephrology, University Medical Centre Utrecht, Utrecht, The Netherlands
| | - Hiske Wellink
- Department of Nephrology, VU Medical Center, Amsterdam, The Netherlands
| | - Elly M van Duijnhoven
- Division of Nephrology, Department of Internal Medicine, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Andries J Hoitsma
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Luuk B Hilbrands
- Department of Nephrology, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Andrea W M Evers
- Institute of Psychology, Health, Medical and Neuropsychology Unit, Leiden University, Leiden, The Netherlands.,Department of Medical Psychology, Radboud University Medical Center, Nijmegen, The Netherlands.,Department of Psychiatry, Leiden University Medical Center, Leiden, The Netherlands
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15
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Kobayashi S, Akaho R, Omoto K, Shirakawa H, Shimizu T, Ishida H, Tanabe K, Nishimura K. Post-donation satisfaction in kidney transplantation: a survey of living donors in Japan. BMC Health Serv Res 2019; 19:755. [PMID: 31655578 PMCID: PMC6815382 DOI: 10.1186/s12913-019-4556-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 09/24/2019] [Indexed: 11/10/2022] Open
Abstract
Background No studies using a valid, standardized method to measure post-donation satisfaction levels among living kidney donors (LKDs) have been published. Methods Donor satisfaction levels were measured using the Japanese version of the Client Satisfaction Questionnaire-8 (CSQ-8), a validated, self-report questionnaire. To identify factors related to post-donation satisfaction levels, we compared donors’ sociodemographic and psychological characteristics and health-related quality of life (HRQoL), using the Short Form-36 Health Survey (SF-36), as well as recipients’ clinical characteristics and SF-36 scores between donors with and without low satisfaction. In addition, donors’ perceptions of the donation results and transplant procedure were assessed using measures that we developed. Results The mean (standard deviation [SD]) CSQ-8 score for the 195 participants was 26.9 (3.4). Twenty-nine (14.9%) respondents with total scores < 1 SD below the mean CSQ-8 score were placed into the low satisfaction group. Multiple logistic regression analysis demonstrated that lower perceptions of receiving adequate information prior to transplantation (odds ratio [OR] = 0.17; 95% confidence interval [CI] = 0.079–0.379; p < 0.001), lower optimism according to the Life Orientation Test (OR = 1.24; 95% CI = 1.045–1.470; p = 0.014), and increased serum creatinine levels in the paired recipient (OR = 0.05; 95% CI = 0.250–1.011; p = 0.054) independently increased the odds of having less satisfaction with donation. Conclusions Our findings suggest that careful pre-donation education and more detailed informed consent may be needed, especially in LKDs with low constitutional optimism.
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Affiliation(s)
- Sayaka Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan.,Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Kawagoe, Japan
| | - Rie Akaho
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Kazuya Omoto
- Department of Urology, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan.,Department of Urology, Toda Chuo General Hospital, Saitama, Japan
| | - Hiroki Shirakawa
- Department of Urology, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan.,Department of Urology, Tokyo Metropolitan Health and Medical Treatment Corporation Okubo Hospital, Tokyo, Japan
| | - Tomokazu Shimizu
- Department of Urology, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan.,Department of Urology, Toda Chuo General Hospital, Saitama, Japan
| | - Hideki Ishida
- Department of Urology, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan.,Department of Organ Transplant Medicine, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Kazunari Tanabe
- Department of Urology, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, School of Medicine, Tokyo, Japan.
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16
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Kook YWA, Shenoy A, Hunt J, Desrosiers F, Gordon-Elliott JS, Jowsey-Gregoire S, Trompeta JA, Vandrovec M, Weinberg S, Fan W, LaPointe Rudow D. Multicenter investigation of the reliability and validity of the live donor assessment tool as an enhancement to the psychosocial evaluation of living donors. Am J Transplant 2019; 19:1119-1128. [PMID: 30414243 DOI: 10.1111/ajt.15170] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Revised: 10/15/2018] [Accepted: 10/21/2018] [Indexed: 01/25/2023]
Abstract
The live donor assessment tool (LDAT) is the first psychosocial assessment tool developed to standardize live donor psychosocial evaluations. A multicenter study was conducted to explore reliability and validity of the LDAT and determine its ability to enhance the psychosocial evaluation beyond its center of origin. Four transplant programs participated, each with their own team of evaluators and unique demographics. Liver and kidney living donors (LDs) undergoing both standard psychosocial evaluation and LDAT from June 2015 to September 2016 were studied. LDAT interrater reliability, associations between LDAT scores and psychosocial evaluation outcome, and psychosocial outcomes postdonation were tested. 386 LD evaluations were compared and had a mean LDAT score of 67.34 ± 7.57. In 140 LDs with two LDATs by different observers, the interrater scores correlated (r = 0.63). LDAT scores at each center and overall stratified to the conventional grouping of psychosocial risk level. LDAT scores of 131 subjects who proceeded with donation were expectedly lower in LDs requiring postdonation counseling (t = -2.78, P = .01). The LDAT had good reliability between raters and predicted outcome of the psychosocial evaluation across centers. It can be used to standardize language among clinicians to communicate psychosocial risk of LD candidates and assist teams when anticipating postdonation psychosocial needs.
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Affiliation(s)
- Yoon Won Amy Kook
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Akhil Shenoy
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Julia Hunt
- Recanati/Miller Transplantation Institute, Mount Sinai Hospital, New York, New York
| | - Farrah Desrosiers
- New York-Presbyterian/Weill Cornell Medical College, New York, New York
| | | | - Sheila Jowsey-Gregoire
- William J. Von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, Minnesota
| | - Joyce A Trompeta
- University of California (UCSF), San Francisco, San Francisco, California
| | - Margo Vandrovec
- William J. Von Liebig Center for Transplantation and Clinical Regeneration Mayo Clinic, Rochester, Minnesota
| | - Sandra Weinberg
- University of California (UCSF), San Francisco, San Francisco, California
| | - Weijia Fan
- Columbia University Mailman School of Public Health, New York, New York
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17
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Lentine KL, Lam NN, Segev DL. Risks of Living Kidney Donation: Current State of Knowledge on Outcomes Important to Donors. Clin J Am Soc Nephrol 2019; 14:597-608. [PMID: 30858158 PMCID: PMC6450354 DOI: 10.2215/cjn.11220918] [Citation(s) in RCA: 80] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
In the past decade, there have been increasing efforts to better define and quantify the short- and long-term risks of living kidney donation. Recent studies have expanded upon the previous literature by focusing on outcomes that are important to potential and previous donors, applying unique databases and/or registries to follow large cohorts of donors for longer periods of time, and comparing outcomes with healthy nondonor controls to estimate attributable risks of donation. Leading outcomes important to living kidney donors include kidney health, surgical risks, and psychosocial effects of donation. Recent data support that living donors may experience a small increased risk of severe CKD and ESKD compared with healthy nondonors. For most donors, the 15-year risk of kidney failure is <1%, but for certain populations, such as young, black men, this risk may be higher. New risk prediction tools that combine the effects of demographic and health factors, and innovations in genetic risk markers are improving kidney risk stratification. Minor perioperative complications occur in 10%-20% of donor nephrectomy cases, but major complications occur in <3%, and the risk of perioperative death is <0.03%. Generally, living kidney donors have similar or improved psychosocial outcomes, such as quality of life, after donation compared with before donation and compared with nondonors. Although the donation process should be financially neutral, living kidney donors may experience out-of-pocket expenses and lost wages that may or may not be completely covered through regional or national reimbursement programs, and may face difficulties arranging subsequent life and health insurance. Living kidney donors should be fully informed of the perioperative and long-term risks before making their decision to donate. Follow-up care allows for preventative care measures to mitigate risk and ongoing surveillance and reporting of donor outcomes to inform prior and future living kidney donors.
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Affiliation(s)
- Krista L Lentine
- Saint Louis University Center for Abdominal Transplantation, St. Louis, Missouri; .,Department of Medicine, Saint Louis University School of Medicine, St. Louis, Missouri
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada; and
| | - Dorry L Segev
- Department of Surgery and .,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, Maryland
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18
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Hiragi S, Goto R, Tanaka Y, Matsuyama Y, Sawada A, SakaI K, Miyata H, Tamura H, Yanagita M, Kuroda T, Ogawa O, Kobayashi T. Estimating the Net Utility Gains Among Donors and Recipients of Adult Living Donor Kidney Transplant. Transplant Proc 2019; 51:676-683. [PMID: 30979450 DOI: 10.1016/j.transproceed.2019.01.049] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Accepted: 01/15/2019] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Living donor kidney transplant relieves the disease burden of patients with end-stage renal disease but may shorten donor life expectancy; however, their quality of life (QOL) is preserved. Nevertheless, the magnitude of the net gain of this procedure is unknown. We evaluated the QOL of both donors and recipients concurrently and calculated the net utility gain. METHODS We recruited 210 subjects who visited the kidney transplantation clinic of a university hospital. Subjects were asked to complete the 5-level EQ-5D-based questionnaire, and patient characteristics were extracted from their medical records. We performed multivariate tobit models analysis to evaluate the QOL change caused by transplant surgery and subsequently ran computational simulations to determine the net utility gains of donors and recipients. We also performed sensitivity analyses. RESULTS After excluding 16 answers with missing data, we analyzed 203 answers in total. After the transplant surgery, recipients gained 0.07 in utility value while donors lost 0.04. In the net utility analysis, we found that the quality-adjusted life years gained ranged from 7.2 to 7.8 in the most favorable case observed in the combination of middle-aged recipients and elderly donors. Assuming no utility discount, the most favorable combination was that with older donors and younger recipients. CONCLUSIONS These findings indicated that the QOL improvement in recipients was larger than the loss among donors. When calculating the net utilities, a combination of middle-aged recipients and elderly donors yielded the largest net utility, but this was likely derived from assumption in the discount of QOL.
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Affiliation(s)
- S Hiragi
- Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan; Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - R Goto
- Graduate School of Business Administration, Keio University, Kanagawa, Japan; Keio Business School, Keio University, Kanagawa, Japan
| | - Y Tanaka
- Division of Nursing, Kyoto University Hospital, Kyoto, Japan
| | - Y Matsuyama
- Division of Nursing, Kyoto University Hospital, Kyoto, Japan
| | - A Sawada
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - K SakaI
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - H Miyata
- Kyoto-Katsura Hospital, Kyoto, Japan
| | - H Tamura
- Center for Innovative Research and Education in Data Science, Institute for Liberal Arts and Sciences, Kyoto University, Kyoto, Japan
| | - M Yanagita
- Department of Nephrology, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - T Kuroda
- Division of Medical Informatics and Administration Planning, Kyoto University Hospital, Kyoto, Japan
| | - O Ogawa
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan.
| | - T Kobayashi
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto, Japan
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19
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Noda T, Kobayashi S, Sawamura J, Oshibuchi H, Nishimura K. Withdrawal of the Decision to Donate Kidney by Living Related Donors: A Single-center Study in Japan. Transplant Proc 2018; 50:3045-3052. [PMID: 30577164 DOI: 10.1016/j.transproceed.2018.06.031] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2018] [Accepted: 06/27/2018] [Indexed: 10/28/2022]
Abstract
BACKGROUND In Japan, 90% of kidney transplantations involve living related donors. A third-party interview is conducted during latter stages of preparation for transplantation to ensure the donor's voluntary decision-making. In this study, we investigated the factors responsible for withdrawal of decision for kidney donation by related living donors after third-party interview. METHODS Related living donor candidates were divided into 2 groups based on their final decision: those who finally donated the kidney (FDG; n = 435); and those who withdrew their decision after third-party interview (WG; n = 11). The psychosocial and medical variables were compared and the reasons for withdrawal were investigated. RESULTS Multiple logistic regression analysis revealed that none of the variables were significantly related to WG. Six categories of reasons for withdrawal were identified: "avoiding pregnancy risk"; "selecting alternative treatment"; "avoiding physical burden for donor"; "recipients' intemperance"; "need to take more time for decision-making"; and "psychological pressure." CONCLUSION A certain number of donor candidates withdrew their decision for different reasons, even in the latter stages of the transplant preparation. Careful verification of the donor candidates' individual situation and provision of adequate information and time are important to protect the donor's right to refuse.
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Affiliation(s)
- T Noda
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - S Kobayashi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan; Department of Psychiatry, Saitama Medical Center, Saitama Medical University, Saitama, Japan.
| | - J Sawamura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - H Oshibuchi
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
| | - K Nishimura
- Department of Psychiatry, Tokyo Women's Medical University, Tokyo, Japan
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20
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Abstract
The best treatment option for many patients with kidney failure is a kidney transplant from a living donor. Countries that successfully increase their rate of living kidney donation will decrease their reliance on dialysis, the most expensive and high-risk form of kidney replacement therapy. Outlined here are some barriers that prevent some patients from pursuing living kidney donation and current knowledge on some potential solutions to these barriers. Also described are strategies to promote living kidney donation in a defensible system of practice. Safely increasing the rate of living kidney donation will require better programs and policies to improve the experiences of living donors and their recipients, to safeguard the practice for years to come.
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Affiliation(s)
- Amit X Garg
- Department of Medicine, Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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21
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Reese PP, Allen MB, Carney C, Leidy D, Levsky S, Pendse R, Mussell AS, Bermudez F, Keddem S, Thiessen C, Rodrigue JR, Emanuel EJ. Outcomes for individuals turned down for living kidney donation. Clin Transplant 2018; 32:e13408. [DOI: 10.1111/ctr.13408] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2017] [Revised: 08/31/2018] [Accepted: 09/08/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Peter P. Reese
- Department of Biostatistics and Epidemiology; University of Pennsylvania Perelman School of Medicine; Philadelphia Pennsylvania
- Renal Division; University of Pennsylvania Perelman School of Medicine; Philadelphia Pennsylvania
- Department of Medical Ethics and Health Policy; University of Pennsylvania Perelman School of Medicine; Philadelphia Pennsylvania
- Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute; Philadelphia Pennsylvania
| | - Matthew B. Allen
- Department of Medicine; Brigham and Women’s Hospital; Boston Massachusetts
| | - Caroline Carney
- Center for Health Incentives and Behavioral Economics at the Leonard Davis Institute; Philadelphia Pennsylvania
| | - Daniel Leidy
- Department of Biostatistics and Epidemiology; University of Pennsylvania Perelman School of Medicine; Philadelphia Pennsylvania
| | - Simona Levsky
- School of Arts and Sciences; University of Pennsylvania; Philadelphia Pennsylvania
| | - Ruchita Pendse
- School of Arts and Sciences; University of Pennsylvania; Philadelphia Pennsylvania
| | - Adam S. Mussell
- Department of Biostatistics and Epidemiology; University of Pennsylvania Perelman School of Medicine; Philadelphia Pennsylvania
| | | | - Shimrit Keddem
- Crescenz Veterans Affairs Medical Center, Center for Evaluation of the Patient Aligned Care Team; Philadelphia Pennsylvania
| | - Carrie Thiessen
- Department of Surgery; Yale University School of Medicine; New Haven Connecticut
| | - James R. Rodrigue
- Department of Surgery; Beth Israel Deaconess, Harvard Medical School; Boston Massachusetts
| | - Ezekiel J. Emanuel
- Department of Medical Ethics and Health Policy; University of Pennsylvania Perelman School of Medicine; Philadelphia Pennsylvania
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22
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Prasad GVR. Understanding the sex disparity in living kidney donation. J Eval Clin Pract 2018; 24:999-1004. [PMID: 30062839 DOI: 10.1111/jep.13015] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Revised: 07/06/2018] [Accepted: 07/11/2018] [Indexed: 12/18/2022]
Abstract
Living donors are the preferred source of organs for kidney transplantation, which is the treatment modality of choice for end-stage kidney disease. Health care systems widely promote living kidney donation. However, women are consistently overrepresented among living donors. The reasons behind the sex-based disparity in living kidney donation remain poorly understood. Compared to women, men possess a greater amount of kidney function, and the higher deceased donation rate among men reflects their higher overall kidney quality. A plausible medical explanation for the sex-based disparity in living kidney donation includes an uncompromising emphasis on preserving donor health, with less emphasis placed on organ quality, which is the main criterion in deceased donor selection. On the other hand, consent to deceased donation is also greater in women, indicating their greater desire to donate even though fewer women actually become deceased donors. Therefore, nonmedical reasons for the sex disparity in living donation must be sought. Increased empathic distress or emotional memory; a greater sense of responsibility, urgency, and impulsiveness with increased reaction to empathy; a different body image; and a different social status may all contribute to greater living kidney donation in women. Economic inequity may be the singular explanation when personal worth links to economic worth. To better understand the sex disparity in living kidney donation, we need better data on the reasons behind both nondonation and donor rejection after evaluation in clinical practice. Nondirected living kidney donation provides unique opportunities to minimize factors such as emotional distress, empathy, and impulsiveness. More liberal acceptance criteria for donors with isolated medical abnormalities and testing legitimate donor reimbursement strategies based on actual income levels rather than a fixed amount can assist in both ascertaining the reasons behind the sex disparity in living kidney donation and increasing overall living kidney donation rates.
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Affiliation(s)
- G V Ramesh Prasad
- Division of Nephrology, St. Michael's Hospital and University of Toronto, Toronto, Canada
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23
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Holscher CM, Leanza J, Thomas AG, Waldram MM, Haugen CE, Jackson KR, Bae S, Massie AB, Segev DL. Anxiety, depression, and regret of donation in living kidney donors. BMC Nephrol 2018; 19:218. [PMID: 30180815 PMCID: PMC6122576 DOI: 10.1186/s12882-018-1024-0] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2018] [Accepted: 08/28/2018] [Indexed: 01/04/2023] Open
Abstract
Background Previous studies have reported a wide range of prevalence of post-donation anxiety, depression, and regret in living kidney donors (LKDs). It is also unclear what risk factors are associated with these outcomes. Methods We screened 825 LKDs for anxiety and depression using 2-item GAD-2 and PHQ-2 scales and asked about regret. Results Overall, 5.5% screened positive for anxiety, 4.2% for depression, and 2.1% reported regretting their donation. While there was moderate correlation between positive anxiety and depression screens (r = 0.52), there was no correlation between regret and positive screens (r < 0.1 for both). A positive anxiety screen was more likely in LKDs with a positive depression screen (adjusted relative risk [aRR] 13.72, 95% confidence interval [CI] 6.78–27.74, p < 0.001). Similarly, a positive depression screen was more likely in LKDs with a positive anxiety screen (aRR 19.50, 95% CI 6.94–54.81, p < 0.001), as well as in those whose recipients experienced graft loss (aRR 5.38, 95% CI 1.29–22.32, p = 0.02). Regret was more likely in LKDs with a positive anxiety screen (aRR 5.68, 95% CI 1.20–26.90, p = 0.03). This was a single center cross-sectional study which may limit generalizability and examination of causal effects. Also, due to the low prevalence of adverse psychosocial outcomes, we may lack power to detect some associations between donor characteristics and anxiety, depression, or regret. Conclusions Although there is a low prevalence of anxiety, depression, and regret of donation among LKDs, these are interrelated conditions and a positive screen for one condition should prompt evaluation for other conditions.
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Affiliation(s)
- Courtenay M Holscher
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA.
| | - Joseph Leanza
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA
| | - Alvin G Thomas
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA
| | - Madeleine M Waldram
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA
| | - Christine E Haugen
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA
| | - Kyle R Jackson
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA
| | - Sunjae Bae
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Allan B Massie
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Dorry L Segev
- Department of Surgery, Johns Hopkins University School of Medicine, 2000 E. Monument St., Baltimore, MD, 21205, USA.,Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
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24
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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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25
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Positive and Negative Affects in Living Kidney Donors. Transplant Proc 2018; 49:2036-2039. [PMID: 29149957 DOI: 10.1016/j.transproceed.2017.09.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2017] [Accepted: 09/23/2017] [Indexed: 12/19/2022]
Abstract
OBJECTIVE This study aimed to identify the factors influencing the positive and negative affects and the health-related quality of life (HRQOL) of living kidney donors. METHODS With the use of a cross-sectional study design and a structured questionnaire, information on the basic characteristics, positive affect, negative affect, and HRQOL of 41 living kidney donors were compared. RESULTS The negative affect in living kidney donors was similar to that of the general population, but the positive affect was slightly lower. The physical HRQOL of living kidney donors was slightly higher than that of the general population, and the mental HRQOL was similar. Female donors showed a greater positive affect than male donors. The donors who were siblings of the recipients showed a more negative affect. Donors without chronic disease and with good perceived physical health showed improved positive affect, negative affect, and mental HRQOL. Furthermore, living kidney donors with better positive and negative affects showed improved physical and mental HRQOLs. CONCLUSIONS Clinical health providers should evaluate and determine the positive affect, negative affect, and quality of life of living kidney donors, especially in men, siblings of the recipients, those with chronic disease, and those with poorer perceived physical health. Moreover, psychosocial interventions should be provided to improve these factors.
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26
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Lam NN, Lentine KL, Klarenbach S, Sood MM, Kuwornu PJ, Naylor KL, Knoll GA, Kim SJ, Young A, Garg AX. Validation of Living Donor Nephrectomy Codes. Can J Kidney Health Dis 2018; 5:2054358118760833. [PMID: 29662679 PMCID: PMC5896849 DOI: 10.1177/2054358118760833] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Accepted: 11/15/2017] [Indexed: 11/21/2022] Open
Abstract
Background: Use of administrative data for outcomes assessment in living kidney donors is increasing given the rarity of complications and challenges with loss to follow-up. Objective: To assess the validity of living donor nephrectomy in health care administrative databases compared with the reference standard of manual chart review. Design: Retrospective cohort study. Setting: 5 major transplant centers in Ontario, Canada. Patients: Living kidney donors between 2003 and 2010. Measurements: Sensitivity and positive predictive value (PPV). Methods: Using administrative databases, we conducted a retrospective study to determine the validity of diagnostic and procedural codes for living donor nephrectomies. The reference standard was living donor nephrectomies identified through the province’s tissue and organ procurement agency, with verification by manual chart review. Operating characteristics (sensitivity and PPV) of various algorithms using diagnostic, procedural, and physician billing codes were calculated. Results: During the study period, there were a total of 1199 living donor nephrectomies. Overall, the best algorithm for identifying living kidney donors was the presence of 1 diagnostic code for kidney donor (ICD-10 Z52.4) and 1 procedural code for kidney procurement/excision (1PC58, 1PC89, 1PC91). Compared with the reference standard, this algorithm had a sensitivity of 97% and a PPV of 90%. The diagnostic and procedural codes performed better than the physician billing codes (sensitivity 60%, PPV 78%). Limitations: The donor chart review and validation study was performed in Ontario and may not be generalizable to other regions. Conclusions: An algorithm consisting of 1 diagnostic and 1 procedural code can be reliably used to conduct health services research that requires the accurate determination of living kidney donors at the population level.
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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 School of Medicine, MO, USA
| | - Scott Klarenbach
- Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, Canada
| | - Manish M Sood
- Department of Medicine, Division of Nephrology, Kidney Research Centre, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
| | - Paul J Kuwornu
- Institute for Clinical Evaluative Sciences, Ontario, Canada
| | - Kyla L Naylor
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Ontario, Canada
| | - Gregory A Knoll
- Department of Medicine, Division of Nephrology, Kidney Research Centre, Ottawa, Ontario, Canada.,Clinical Epidemiology Program, Ottawa Health Research Institute, Ontario, Canada
| | - S Joseph Kim
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,Department of Medicine, Division of Nephrology, University of Toronto, Ontario, Canada
| | - Ann Young
- Department of Medicine, Division of Nephrology, University of Toronto, Ontario, Canada
| | - Amit X Garg
- Institute for Clinical Evaluative Sciences, Ontario, Canada.,Department of Medicine, Division of Nephrology, Western University, London, Ontario, Canada.,Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
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27
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Nöhre M, Pollmann I, Mikuteit M, Weissenborn K, Gueler F, de Zwaan M. Partnership Satisfaction in Living Kidney Donors. Front Psychiatry 2018; 9:353. [PMID: 30123146 PMCID: PMC6085414 DOI: 10.3389/fpsyt.2018.00353] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2018] [Accepted: 07/16/2018] [Indexed: 12/13/2022] Open
Abstract
Due to organ shortage, living kidney donation is gaining increasing importance. Medical progress enables a successful transplantation between unrelated individuals, even individuals with AB0-incompatibilities. Spouses are the largest group of living kidney donors. The aim of this study was to assess partnership status and partnership satisfaction in living kidney donors. In the cross-sectional study we investigated 361 living kidney donors. The time since donation ranged between 1 and 38 years. The partnership satisfaction was assessed with the German version of the Quality of Marriage Index. We compared the donor sample with a representative German population sample (n = 1995). In addition, we compared donors who have donated to their partner (spouse donors) to those who have donated to someone else (non-spouse donors). In comparison to the population sample significantly more kidney donors were living in a relationship (82 vs. 60%). Most donors reported an unchanged (76.6%) or improved (20.5%) relationship to the recipient since transplantation. A significantly higher partnership satisfaction could be found in the donor sample compared to the population sample which was mainly due to a higher partnership satisfaction of the spouse donors compared to the non-spouse donors. High partnership satisfaction in living kidney donors might be an indicator for a successful selection process before transplantation. Alternatively, kidney donation might have a stabilizing or even positive impact on the partnership. Due to the design of our study causative interpretations cannot be made. Therefore, prospective studies are required to assess partnership satisfaction before and after living kidney donation.
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Affiliation(s)
- Mariel Nöhre
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Iris Pollmann
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
| | - Marie Mikuteit
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany.,Department of Neurology, Hannover Medical School, Hannover, Germany.,Department of Nephrology, Hannover Medical School, Hannover, Germany
| | | | - Faikah Gueler
- Department of Nephrology, Hannover Medical School, Hannover, Germany
| | - Martina de Zwaan
- Department of Psychosomatic Medicine and Psychotherapy, Hannover Medical School, Hannover, Germany
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28
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Lanot A, Bouvier N, Chatelet V, Lecouf A, Tillou X, Hurault de Ligny B. [Outcome of living kidney donors for transplantation]. Nephrol Ther 2017; 13:448-459. [PMID: 29031488 DOI: 10.1016/j.nephro.2017.02.011] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2016] [Revised: 01/24/2017] [Accepted: 02/01/2017] [Indexed: 01/10/2023]
Abstract
Nowadays, several treatments exist to treat terminal chronic renal failure. Best results for the recipients are obtained with kidney transplantation concerning mortality and quality of life. Transplantation is also the cheaper option for society. Living kidney donation raises the issue of the becoming of the donor, an absolutely healthy subject who gets to a surgical procedure. The becoming of living kidney donors has been compared with the one of controls subjects in several studies. The evaluations focused on the complications of nephrectomy in the short and long-term: kidney failure, hypertension, proteinuria, possibility of pregnancy, quality of life, and mortality. The first results did not show any risk linked to kidney donation, compared to general population. However, since 2013, kidney donors were found at higher risk for kidney failure and even for mortality, compared with controls selected like donor candidates. The risk of kidney donation is nevertheless acceptable and minimal, on the condition of rigorous selection of candidates and regular follow-up.
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Affiliation(s)
- Antoine Lanot
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France.
| | - Nicolas Bouvier
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France
| | - Valérie Chatelet
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Angélique Lecouf
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Xavier Tillou
- Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France; Service d'urologie, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France
| | - Bruno Hurault de Ligny
- Service de néphrologie, dialyse et transplantation, CUMR, CHU de Caen, avenue de la Côte-de-Nacre, 14033 Caen cedex 9, France; Normandie université, Unicaen, UFR de médecine, 2 rue des rochambelles, 14032 Caen cedex, France
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29
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Massey EK, Timmerman L, Ismail SY, Duerinckx N, Lopes A, Maple H, Mega I, Papachristou C, Dobbels F. The ELPAT living organ donor Psychosocial Assessment Tool (EPAT): from 'what' to 'how' of psychosocial screening - a pilot study. Transpl Int 2017; 31:56-70. [PMID: 28850737 DOI: 10.1111/tri.13041] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Revised: 03/20/2017] [Accepted: 08/14/2017] [Indexed: 11/28/2022]
Abstract
Thorough psychosocial screening of donor candidates is required in order to minimize potential negative consequences and to strive for optimal safety within living donation programmes. We aimed to develop an evidence-based tool to standardize the psychosocial screening process. Key concepts of psychosocial screening were used to structure our tool: motivation and decision-making, personal resources, psychopathology, social resources, ethical and legal factors and information and risk processing. We (i) discussed how each item per concept could be measured, (ii) reviewed and rated available validated tools, (iii) where necessary developed new items, (iv) assessed content validity and (v) pilot-tested the new items. The resulting ELPAT living organ donor Psychosocial Assessment Tool (EPAT) consists of a selection of validated questionnaires (28 items in total), a semi-structured interview (43 questions) and a Red Flag Checklist. We outline optimal procedures and conditions for implementing this tool. The EPAT and user manual are available from the authors. Use of this tool will standardize the psychosocial screening procedure ensuring that no psychosocial issues are overlooked and ensure that comparable selection criteria are used and facilitate generation of comparable psychosocial data on living donor candidates.
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Affiliation(s)
- Emma K Massey
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Lotte Timmerman
- Department of Internal Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Sohal Y Ismail
- Department of Psychiatry, Erasmus Medical Centre, Rotterdam, the Netherlands
| | - Nathalie Duerinckx
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium.,Heart Transplant Program, Department of Cardiovascular Sciences, University Hospitals of Leuven, Leuven, Belgium
| | - Alice Lopes
- Psychiatry and Health Psychology Unit, Centro Hospitalar do Porto, Porto, Portugal
| | - Hannah Maple
- Guy's and St Thomas' NHS Foundation Trust and King's College London, London, UK
| | - Inês Mega
- Hepato-Biliar-Pancreatic and Transplantation Center, Hospital Curry Cabral, Lisbon, Portugal
| | - Christina Papachristou
- Department for Psychosomatic Medicine, Charité-Universitätsmedizin Berlin, Berlin, Germany
| | - Fabienne Dobbels
- Department of Public Health and Primary Care, Academic Centre for Nursing and Midwifery, KU Leuven - University of Leuven, Leuven, Belgium
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30
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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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31
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Risk-Factor Profile of Living Kidney Donors: The Australia and New Zealand Dialysis and Transplant Living Kidney Donor Registry 2004-2012. Transplantation 2017; 100:1278-83. [PMID: 27123877 DOI: 10.1097/tp.0000000000000877] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Recent literature suggests that living kidney donation may be associated with an excess risk of end-stage kidney disease and death. Efforts to maximize access to transplantation may result in acceptance of donors who do not fit within current guidelines, potentially placing them at risk of adverse long-term outcomes. METHODS We studied the risk profile of Australian and New Zealand living kidney donors using data from the Australia and New Zealand Dialysis and Transplant Living Kidney Donor Registry over 2004 to 2012. We compared their predonation profile against national guidelines for donor acceptance. RESULTS The analysis included 2,932 donors (mean age 48.8 ± 11.2 years, range 18-81), 58% female and 87% Caucasian. Forty (1%) had measured glomerular filtration rate less than 80 mL/min; 32 (1%) had proteinuria >300 mg/day; 589 (20%) were hypertensive; 495 (18%) obese; 9 (0.3%) were diabetic while a further 55 (2%) had impaired glucose tolerance; and 218 (7%) were current smokers. Overall 767 donors (26%) had at least one relative contraindication to donation and 268 (9%) had at least one absolute contraindication according to national guidelines. CONCLUSIONS Divergence of current clinical practice from national guidelines has occurred. In the context of recent evidence demonstrating elevated long-term donor risk, rigorous follow-up and reporting of outcomes are now mandated to ensure safety and document any change in risk associated with such a divergence.
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Psychosocial Outcomes 3 to 10 Years After Donation in the Adult to Adult Living Donor Liver Transplantation Cohort Study. Transplantation 2017; 100:1257-69. [PMID: 27152918 DOI: 10.1097/tp.0000000000001144] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Studies of liver donors' psychosocial outcomes focus on the short term and rely largely on quality-of-life measures not specific to donation. We sought to examine long-term donation effects on 3 psychosocial domains: perceived physical, emotional, and socioeconomic outcomes. METHODS Individuals donating 3 to 10 years previously at 9 centers were eligible for telephone surveys. Survey responses were examined descriptively. Cluster analysis was used to identify distinct donor groups based on response profiles across psychosocial domains. Potential predictors of response profiles were evaluated with regression analysis. RESULTS Five hundred seventeen donors (66%) participated (M = 5.8 years postdonation, SD = 1.9). Fifteen percent to 48% of donors endorsed current donation-related physical health problems and concerns, and 7%-60% reported socioeconomic concerns (eg, insurance difficulties, financial expenditures). However, on average, donors experienced high psychological growth, and 90% felt positively about donation. Cluster analysis revealed 5 donor groups. One group showed high psychological benefit, with little endorsement of physical or socioeconomic concerns (15% of donors). Four groups showed less favorable profiles, with varying combinations of difficulties. The largest such group showed high endorsement of physical concerns and financial expenditures, and only modest psychological benefit (31% of donors). Men and nonHispanic whites were most likely to have unfavorable response profiles (Ps < 0.01). Compared with donors aged 19 to 30 years, older donors were less likely to have unfavorable profiles; these differences were significant for donors in the >40 to 50 year age group (Ps < 0.008). CONCLUSIONS Even many years postdonation, donors report adverse physical and socioeconomic effects, but positive emotional effects as well. Identification of response profiles and predictors may improve targeting of postdonation surveillance and care.
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Demian MN, Lam NN, Mac-Way F, Sapir-Pichhadze R, Fernandez N. Opportunities for Engaging Patients in Kidney Research. Can J Kidney Health Dis 2017; 4:2054358117703070. [PMID: 28491336 PMCID: PMC5406191 DOI: 10.1177/2054358117703070] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 01/26/2017] [Indexed: 01/03/2023] Open
Abstract
Purpose: The purpose of this review is to provide a summary of the rationale for engaging patients in research as well as to review the established and envisioned advantages and strategies for patient-researcher partnerships. The authors of this article, which include a patient and 4 researchers in kidney disease, discuss the expected benefits and opportunities for patient engagement in their respective research programs. The 4 research programs span the spectrum of kidney disease and focus on enhancing bone health, increasing living donor kidney transplants, improving medication adherence, and preventing kidney transplant rejection. Sources of Information: The sources of information for this review include published studies on the topics of patient engagement and the 4 research programs of the new investigators. Key Findings: (1) Patient, health care provider, and researcher partnerships can contribute useful insights capable of enhancing research in kidney disease. (2) Regardless of the research program, there are various strategies and opportunities for engagement of patients with lived experience across the various stages of research in kidney disease. (3) Envisioned advantages of patient-researcher partnerships include: targeting patient-identified research priorities, integrating patients’ experiential knowledge, improving study design and feasibility through patient-researcher input, facilitating dissemination of research findings to other patients, effectively responding to patient concerns about studies, and inspiring researchers to conduct their research. Limitations: The limitations of the current review include the relative scarcity of literature on patient engagement within the field of kidney disease. Implications: The findings of the current review suggest that it will be important for future studies to identify optimal strategies for patient engagement in setting research priorities, study design, participant recruitment, execution of research projects, and knowledge dissemination and translation.
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Affiliation(s)
- Maryam N Demian
- Department of Psychology, Simon Fraser University, Burnaby, British Columbia, Canada
| | - Ngan N Lam
- Division of Nephrology, Department of Medicine, University of Alberta, Edmonton, Canada
| | - Fabrice Mac-Way
- Division of Nephrology, Department of Medicine, Laval University, Quebec City, Québec, Canada
| | - Ruth Sapir-Pichhadze
- Division of Nephrology, Department of Medicine, McGill University, Montreal, Québec, Canada
| | - Nicolas Fernandez
- Department of Family Medicine and Emergency Medicine, Université de Montréal, Québec, Canada
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Torres X, Comas J, Arcos E, Tort J, Diekmann F. Death of recipients after kidney living donation triples donors' risk of dropping out from follow-up: a retrospective study. Transpl Int 2017; 30:603-610. [PMID: 28252226 DOI: 10.1111/tri.12946] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2016] [Revised: 08/25/2016] [Accepted: 02/24/2017] [Indexed: 11/28/2022]
Abstract
Although kidney transplantation from the donation of a living donor is a safe treatment for end-stage renal disease, inferences about safety of living kidney donors might be biased by an informative censoring caused by the noninclusion of a substantial percentage of donors lost to follow-up. With the aim of assessing the presence of a potential informative censoring in living kidney donation outcomes of Catalan donors for a period of 12 years, 573 donors followed and lost to follow-up were compared. Losses of follow-up over time were also assessed by univariate and multivariate survival analysis, along with Cox regression. Younger and older ages, and the death of their recipient differentiated those donors who were lost to follow-up over time. The risk of dropping out from follow-up was more than twofold for the youngest and oldest donors, and almost threefold for those donors whose recipient died. Results of studies on postdonation outcomes of Catalan living kidney donors might have overlooked older and younger cases, and, remarkably, a percentage of donors whose recipient died. If these donors showed a higher incidence of psychological problems, conclusions about living donors' safety might be compromised thus emphasizing the necessity of sustained surveillance of donors and prompt identification of these cases.
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Affiliation(s)
- Xavier Torres
- Psychiatry and Clinical Psychology Service, Institut Clínic de Neurociències, Hospital Clínic de Barcelona, Barcelona, Spain
| | - Jordi Comas
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Emma Arcos
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Jaume Tort
- Catalan Renal Registry, Catalan Transplant Organization, Health Department, Generalitat of Catalonia, Barcelona, Spain
| | - Fritz Diekmann
- Department of Nephrology and Kidney Transplantation, Hospital Clínic de Barcelona, Barcelona, Spain
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Meyer KB, Bjørk IT, Wahl AK, Lennerling A, Andersen MH. Long-term experiences of Norwegian live kidney donors: qualitative in-depth interviews. BMJ Open 2017; 7:e014072. [PMID: 28209606 PMCID: PMC5318577 DOI: 10.1136/bmjopen-2016-014072] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
OBJECTIVE Live kidney donation is generally viewed as a welcome treatment option for severe kidney disease. However, there is a disparity in the body of research on donor experiences and postdonation outcome, and lack of knowledge on long-term consequences described by the donors. This study was conducted to provide insight into donors' subjective meanings and interpretation of their experiences ∼10 years after donation. DESIGN Qualitative explorative in-depth interviews. The sampling strategy employed maximum variation. Setting Oslo University Hospital is the national centre for organ transplantation and donation in Norway, and there are 26 local nephrology centres. PARTICIPANTS 16 donors representing all parts of Norway who donated a kidney in 2001-2004 participated in the study. The interviews were analysed using an interpretative approach. RESULTS The analysis resulted in 4 main themes; the recipient outcome justified long-term experiences, family dynamics-tension still under the surface, ambivalence-healthy versus the need for regular follow-up, and life must go on. These themes reflect the complexity of live kidney donation, which fluctuated from positive experiences such as pride and feeling privileged to adverse experiences such as altered family relationships or reduced health. CONCLUSIONS Live kidney donors seemed to possess resilient qualities that enabled them to address the long-term consequences of donation. The challenge is to provide more uniform information about long-term consequences. In future research, resilient qualities could be a topic to explore in live donation.
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Affiliation(s)
- Käthe B Meyer
- Department of Transplantation, Oslo University Hospital, Rikshospitalet, Norway
- Institute of Clinical Medicine University of Oslo, Oslo, Norway
| | | | | | - Annette Lennerling
- Department of Transplantation, Sahlgrenska University Hospital, Gothenburg, Sweden
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Han X, Lim JYM, Raman L, Tai BC, Kaur H, Goh ATH, Vathsala A, Tiong HY. Nephrectomy-induced reduced renal function and the health-related quality of life of living kidney donors. Clin Transplant 2017; 31. [PMID: 28083977 DOI: 10.1111/ctr.12910] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/06/2017] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To evaluate the health impact of nephrectomy on living kidney donors (LKDs) by comparing the health-related quality of life (HrQOL) scores measured by Short Form-36 (SF36) between those with and without postdonation renal function impairment (PRFI). METHODS Eighty-two LKDs (47 females, mean age=50.2±11.2 years) were prospectively recruited to participate in a SF-36 HrQOL survey. Chart review, individual baseline, and postoperative renal function (eGFR) was determined using the Modification of Diet in Renal Disease formula. PRFI was defined as eGFR<60 mL/min/1.73 m2 or proteinuria. Mean SF-36 domain scores were compared between those with and without PRFI. RESULTS After a median follow-up of 5.7 years, the prevalence of postdonation comorbidities was 29.3% (n=24) PRFI, 25.6% (n=21) hypertension, 6.1% (n=5) diabetes, and 3.7% (n=3) heart disease, and no LKDs developed end-stage renal disease. Mean eGFR before and after donor nephrectomy was 95.5±23.4 and 71.0±17.3 mL/min/1.73 m2 (P<.01). Mean SF-36 scores of LKDs were not significantly different between those with and without PRFI in all the domains (all P>.05). Similarly, the proportion of LKDs with PRFI did not differ significantly between the patients with SF-36 domain scores above and below the published reference values. CONCLUSION Nephrectomy-induced PRFI may not have a significant impact on the HrQOL of the LKD population with a low proportion of other major comorbidities such as diabetes and ischemic heart disease.
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Affiliation(s)
- Xiao Han
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Joel Yu Ming Lim
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Lata Raman
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University Hospital, National University Health System, Singapore, Singapore
| | - Hersharan Kaur
- Department of Nephrology, National University Hospital, National University Health System, Singapore, Singapore
| | - Angeline Ting Hui Goh
- Department of Nephrology, National University Hospital, National University Health System, Singapore, Singapore
| | - Anantharaman Vathsala
- Department of Nephrology, National University Hospital, National University Health System, Singapore, Singapore
| | - Ho Yee Tiong
- Department of Urology, National University Hospital, National University Health System, Singapore, Singapore
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Chen KH, Yeh LC, Huang HL, Chiang YJ, Lin MH, Hsieh CY, Weng LC. Factors Determining Physical and Mental Quality of Life of Living Kidney Donors in Taiwan. Transplant Proc 2017; 48:745-8. [PMID: 27234727 DOI: 10.1016/j.transproceed.2015.12.060] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Revised: 12/08/2015] [Accepted: 12/30/2015] [Indexed: 12/11/2022]
Abstract
BACKGROUND Living-donor kidney transplantation has a positive influence on recipients' life expectancy and improves quality of life for patients with end-stage renal disease compared with dialysis patients. Evaluation of the physical and mental quality of life for donors can promote positive perceptions about donation and help potential donors in their decision-making process. The aim of this study was to explore the predictive factors of quality of life for living kidney donors. METHODS A cross-sectional and descriptive design was used, and the study was conducted from January to July 2013. The donors were a convenience sample of 34 participants who had undergone kidney transplant surgery >1 year earlier. RESULTS The results showed that kidney donors had a low to moderate physical and mental quality of life. Multiple regression analysis revealed that financial concerns and anxiety explained 27.8% of the total variance of quality of life in the physical component. Anxiety and paid work explained 61.4% of the total variance of quality of life in the mental component. CONCLUSIONS After renal transplantation, living kidney donors experienced low to moderate quality of life. Because donors are family members (siblings, sons or daughters, spouses, or parents), monthly family income is a significant issue that influences both the decision to donate and quality of life after transplantation. Our findings suggest that pre-transplantation assessment must include social workers as part of the health care team to evaluate the impact of a donor's financial status on post-transplantation quality of life.
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Affiliation(s)
- K-H Chen
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - L-C Yeh
- Kang-Ning Junior College of Medical Care and management, Taipei, Taiwan
| | - H-L Huang
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan
| | - Y-J Chiang
- Transplantation center & Urology surgery, Chang Gung Medical Foundation-Linkuo Medical Center, Taoyuan, Taiwan
| | - M-H Lin
- Department of Nursing, Chang Gung Medical Foundation-Linkuo Medical Center, Taoyuan, Taiwan
| | - C-Y Hsieh
- Department of Nursing, Chang Gung Medical Foundation-Linkuo Medical Center, Taoyuan, Taiwan
| | - L-C Weng
- School of Nursing, College of Medicine, Chang Gung University, Tao-Yuan, Taiwan.
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Timsit MO, Kleinclauss F, Mamzer Bruneel M, Thuret R. Le donneur vivant de rein. Prog Urol 2016; 26:940-963. [DOI: 10.1016/j.purol.2016.09.054] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2016] [Revised: 08/29/2016] [Accepted: 09/01/2016] [Indexed: 01/10/2023]
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Prasad GVR. Distinguishing internal property from external property in kidney transplantation. J Eval Clin Pract 2016; 22:539-43. [PMID: 27198733 DOI: 10.1111/jep.12571] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2016] [Revised: 04/26/2016] [Accepted: 04/27/2016] [Indexed: 11/29/2022]
Abstract
What determines the ownership of human body parts? In this paper, I argue that this question can be informed by an exploration of the cognitive distinction between property external to the human body such as houses, cars or land, and internal property such as organs that are located within anatomical body confines. Each type of property has distinct brain representations and possibly different effects on the sense of self. This distinction may help explain the divergence in post-donation outcomes seen in different kidney donor populations. Poor outcomes in some types of kidney donors may be due not only to a failure in their proper selection by standard medical testing or post-donation care but may also be a manifestation of differing effects on sense of self resulting from transfer of their internal property. Because a kidney is internal property, a hypothesis worth exploring is that those who experience good outcomes post-donation experience dopaminergic activation and a feeling of reward, while those experiencing bad outcomes are instead overcoming cortisol or adrenergic-based stress or fear responses without a corresponding feeling of reward, disrupting of their sense of self. Discussions about the rules for internal property transfer must be based not only on values and laws designed to govern external property but also on cognitive science-based facts, values and judgments that discussions of external property do not presently accommodate. Any future system of rules for governing organ distribution requires a framework different from that of external property to prevent harm to living kidney donors.
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Affiliation(s)
- G V Ramesh Prasad
- St. Michael's Hospital, Toronto, ON, Canada.,University of Toronto, Toronto, Canada
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Hays R, Rodrigue JR, Cohen D, Danovitch G, Matas A, Schold J, LaPointe Rudow D. Financial Neutrality for Living Organ Donors: Reasoning, Rationale, Definitions, and Implementation Strategies. Am J Transplant 2016; 16:1973-81. [PMID: 27037542 DOI: 10.1111/ajt.13813] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2015] [Revised: 03/13/2016] [Accepted: 03/19/2016] [Indexed: 01/25/2023]
Abstract
In the United States, live organ donation can be a costly and burdensome undertaking for donors. While most donation-related medical expenses are covered, many donors still face lost wages, travel expenses, incidentals, and potential for future insurability problems. Despite widespread consensus that live donors (LD) should not be responsible for the costs associated with donation, little has changed to alleviate financial burdens for LDs in the last decade. To achieve this goal, the transplant community must actively pursue strategies and policies to eliminate unreimbursed out-of-pocket costs to LDs. Costs should be more appropriately distributed across all stakeholders; this will also make live donation possible for people who, in the current system, cannot afford to proceed. We propose the goal of LD "financial neutrality," offer an operational definition to include the coverage/reimbursement of all medical, travel, and lodging costs, along with lost wages, related to the act of donating an organ, and guidance for consideration of medical care coverage, and wage and other expense reimbursement. The intent of this report is to provide a foundation to inform discussion within the transplant community and to advance initiatives for policy and resource allocation.
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Affiliation(s)
- R Hays
- Transplant Center, University of Wisconsin Hospital and Clinics, Madison, WI
| | - J R Rodrigue
- Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
| | - D Cohen
- Department of Medicine, Columbia University Medical Center, New York, NY
| | - G Danovitch
- Department of Medicine, University of California at Los Angeles, Los Angeles, CA
| | - A Matas
- Department of Surgery, University of Minnesota Medical Center-Fairview, Minneapolis, MN
| | - J Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH
| | - D LaPointe Rudow
- Recanati Miller Transplantation Institute, Mount Sinai Hospital, New York, NY
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Halverson CME, Wang JY, Poulson M, Karlin J, Crowley-Matoka M, Ross LF. Living Kidney Donors Who Develop Kidney Failure: Excerpts of Their Thoughts. Am J Nephrol 2016; 43:389-96. [PMID: 27222023 DOI: 10.1159/000446161] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2016] [Accepted: 04/11/2016] [Indexed: 01/10/2023]
Abstract
BACKGROUND Psychosocial data about living kidney donors have been collected for almost 5 decades now. To date, however, no study has provided any psychosocial follow-up of donors who developed a serious health problem such as end-stage renal disease (ESRD). METHODS Donors who developed ESRD were invited to participate in a qualitative interview if they met one or both of the inclusion criteria: (1) developed ESRD within 10 years of donating and/or (2) lacked health insurance at the time of donation. We contacted 38 individuals who met these criteria, and 22 participated (58%). Two were subsequently excluded from analysis. RESULTS Twenty qualitative interviews were analyzed. Five findings are described: (1) donors describe the decision-making process as spontaneous and fast; (2) donors describe lack of appreciation for the need for post-donation self-care; (3) donors do not regret donating despite the adverse outcome; (4) donors advise future donors to have in place emotional and physical support post donation; and (5) donors appreciate the opportunity to tell their story from being a living donor to living with ESRD, which virtually all perceive as 2 separate unrelated events. CONCLUSIONS Most donors are positive about their donation decision and experience and would donate again, despite developing ESRD themselves. They propose some important changes to the decision-making and informed-consent processes. Our data are reassuring regarding lack of donor regret, but highlight the need for living donor transplant programs to ensure that living donors understand their long-term risks and receive appropriate life-long follow-up care to minimize these risks.
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Timmerman L, Laging M, Timman R, Zuidema WC, Beck DK, IJzermans JN, Betjes MG, Busschbach JJ, Weimar W, Massey EK. The impact of the donors' and recipients' medical complications on living kidney donors' mental health. Transpl Int 2016; 29:589-602. [DOI: 10.1111/tri.12760] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2015] [Revised: 10/28/2015] [Accepted: 02/15/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Lotte Timmerman
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Mirjam Laging
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Reinier Timman
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Willij C. Zuidema
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Denise K. Beck
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan N.M. IJzermans
- Department of General Surgery; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Michiel G.H. Betjes
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Jan J.V. Busschbach
- Department of Psychiatry; Section Medical Psychology and Psychotherapy; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Willem Weimar
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
| | - Emma K. Massey
- Department of Internal Medicine; Section Nephrology and Transplantation; Erasmus Medical Center Rotterdam; Rotterdam The Netherlands
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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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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: 15] [Impact Index Per Article: 1.9] [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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Pérez-San-Gregorio MÁ, Fernández-Jiménez E, Luque-Budia A, Martín-Rodríguez A. Anxiety and concerns in Spanish living kidney donor candidates. Int J Psychiatry Med 2015; 50:163-77. [PMID: 26340911 DOI: 10.1177/0091217415605031] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES Donating a kidney while alive is an experience associated with important benefits for donors and recipients. In view of the inexistence of Spanish investigations, we aimed: (a) to compare the anxiety and concerns of Spanish living kidney donor candidates relating to themselves as a function of gender and their level of concern about potential kidney recipients, and (b) to analyze whether the results regarding anxiety symptoms were clinically significant compared with a representative sample of the general Spanish population. METHODS We selected 67 donor candidates whom we evaluated using the State Trait Anxiety Inventory (STAI) and the Scale of Concerns Regarding Living Kidney Donation. RESULTS (1) The donor candidates who were more concerned about the recipients, in comparison with those who were less concerned, showed more state-anxiety and more concerns about themselves as donors, (2) the subgroup of more concerned females exhibited greater anxiety symptoms and concern about the consequences that nephrectomy could have on themselves, and (3) for all donor candidates, regardless of gender or level of concern about the recipient, the anxiety levels were not clinically significant. CONCLUSIONS Anxiety in donor candidates is similar to or lower than the normative levels.
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Affiliation(s)
| | | | - Asunción Luque-Budia
- Liaison Mental Health Services, University Hospital Virgen del Rocío, Seville, Spain
| | - Agustín Martín-Rodríguez
- Department of Personality, Assessment, and Psychological Treatment, University of Seville, Spain
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Ríos A, López-Navas A, Martínez-Alarcón L, Ramírez P, Parrilla P. Latin Americans in Spain and their attitude toward living kidney donation. Clin Transplant 2015; 29:1054-62. [DOI: 10.1111/ctr.12626] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/31/2015] [Indexed: 01/08/2023]
Affiliation(s)
- A. Ríos
- International Collaborative Donor Project (“Proyecto Colaborativo Internacional Donante”); Murcia Spain
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology; University of Murcia; Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
| | - A. López-Navas
- International Collaborative Donor Project (“Proyecto Colaborativo Internacional Donante”); Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
- Department of Psychology; UCAM; San Antonio Catholic University; Murcia Spain
| | - L. Martínez-Alarcón
- International Collaborative Donor Project (“Proyecto Colaborativo Internacional Donante”); Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
| | - P. Ramírez
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology; University of Murcia; Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
- Regional Transplant Center; Consejería de Sanidad y Consumo de la Región de Murcia; Murcia Spain
| | - P. Parrilla
- Department of Surgery, Paediatrics, Obstetrics and Gynaecology; University of Murcia; Murcia Spain
- Transplant Unit; Surgery Service; IMIB - Virgen de la Arrixaca University Hospital; Murcia Spain
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Jacobs CL, Gross CR, Messersmith EE, Hong BA, Gillespie BW, Hill-Callahan P, Taler SJ, Jowsey SG, Beebe TJ, Matas AJ, Odim J, Ibrahim HN. Emotional and Financial Experiences of Kidney Donors over the Past 50 Years: The RELIVE Study. Clin J Am Soc Nephrol 2015; 10:2221-31. [PMID: 26463883 DOI: 10.2215/cjn.07120714] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 09/02/2015] [Indexed: 12/15/2022]
Abstract
BACKGROUND AND OBJECTIVES Most kidney donors view their experience positively, but some may experience psychosocial and financial burdens. We hypothesized that certain donor characteristics, poor outcome of the recipient, negative perceptions of care, and lack of support may be associated with poor psychosocial outcomes for donors. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Renal and Lung Living Donors Evaluation Study (RELIVE) examined long-term medical and psychosocial outcomes for kidney donors (at three U.S. transplant centers) who donated between 1963 and 2005. Standardized questionnaires evaluated donor perspectives, recovery time, social support, motivation, financial impact, insurability after donation, and current psychological status. Questionnaires were mailed to 6909 donors. RESULTS Questionnaires were returned by 2455 donors, who had donated 17 ± 10 years earlier (range, 5-48 years), a response rate of 36%. Most (95%) rated their overall donation experience as good to excellent. Rating the overall donor experience more negatively was associated with donor complications, psychological difficulties, recipient graft failure, and longer time since donation. Nine percent (n=231) reported one or more of the following poor psychosocial outcomes: fair or poor overall donor experience, financial burden, regret or discomfort with decision to donate, or psychological difficulties since donation. Recipient graft failure was the only predictor for reporting one or more of these poor psychosocial outcomes (odds ratio, 1.77; 95% confidence interval, 1.33 to 2.34). Donors with lower educational attainment experienced greater financial burden. One of five employed donors took unpaid leave; 2% reported health and life insurability concerns. CONCLUSIONS Although the majority of donors viewed their overall donation experience positively, almost 1 in 10 donors reported at least one negative consequence related to donation. Recipient graft failure was associated with poor psychosocial outcome, defined as one or more of these negative consequences. Some donors were financially disadvantaged, and some experienced insurance difficulties. Interventions to avoid negative psychosocial and financial consequences are warranted.
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Affiliation(s)
- Cheryl L Jacobs
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material.
| | - Cynthia R Gross
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Emily E Messersmith
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Barry A Hong
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Brenda W Gillespie
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Peg Hill-Callahan
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sandra J Taler
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Sheila G Jowsey
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Tim J Beebe
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Arthur J Matas
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Jonah Odim
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
| | - Hassan N Ibrahim
- Due to the number of contributing authors, the affiliations are provided in the Supplemental Material
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Lentine KL, Lam NN, Schnitzler MA, Garg AX, Xiao H, Leander SE, Brennan DC, Taler SJ, Axelrod D, Segev DL. Gender differences in use of prescription narcotic medications among living kidney donors. Clin Transplant 2015; 29:927-37. [PMID: 26227016 DOI: 10.1111/ctr.12599] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/27/2015] [Indexed: 11/27/2022]
Abstract
Prescription narcotic use among living kidney donors is not well described. Using a unique database that integrates national registry identifiers for living kidney donors (1987-2007) in the United States with billing claims from a private health insurer (2000-2007), we identified pharmacy fills for prescription narcotic medications in periods 1-4 and >4 yr post-donation and estimated relative likelihoods of post-donation narcotic use by Cox regression. We also compared narcotic fill rates and medication possession ratios (MPRs, defined as (days of medication supplied)/(days observed)), between donors and age- and sex-matched non-donors. Overall, rates of narcotic medication fills were 32.3 and 32.4 per 100 person-years in periods 1-4 and >4 yr post-donation. After age and race adjustment, women were approximately twice as likely as men to fill a narcotic prescription in years 1-4 (adjusted hazard ratio, aHR, 2.28; 95% confidence interval, CI, 1.86-2.79) and >4 yr (aHR 1.70; 95% CI 1.50-1.93). MPRs in donors were low (<2.5% days exposed), and lower than among age- and sex-matched non-donors. Prescription narcotic medication use is more common among women than men in the intermediate term after live kidney donation. Overall, total narcotic exposure is low, and lower than among non-donors from the general population.
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Affiliation(s)
- Krista L Lentine
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.,Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Ngan N Lam
- Division of Nephrology, University of Alberta, Edmonton, AB, Canada
| | - Mark A Schnitzler
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA.,Division of Abdominal Transplantation, Department of Surgery, Saint Louis University School of Medicine, St. Louis, MO, USA
| | - Amit X Garg
- Division of Nephrology, Western University, London, ON, Canada
| | - Huiling Xiao
- Center for Outcomes Research, Saint Louis University School of Medicine, St. Louis, MO, USA
| | | | - Daniel C Brennan
- Transplant Nephrology, Washington University School of Medicine, St. Louis, MO, USA
| | - Sandra J Taler
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA
| | - David Axelrod
- Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH, USA
| | - Dorry L Segev
- Division of Abdominal Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD, USA
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Satisfaction With Life Among Living Kidney Donors: A RELIVE Study of Long-Term Donor Outcomes. Transplantation 2015; 98:1294-300. [PMID: 25136843 DOI: 10.1097/tp.0000000000000360] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND Little is known about living kidney donors' satisfaction with life (SWL) after donation. We compared donors' SWL to previously reported general population samples and investigated predictors of donors' SWL. METHODS Three transplant centers mailed questionnaires to assess SWL, physical health, optimism, retrospective evaluation of the donation experience, and demographic characteristics to living kidney donors' homes between 2010 and 2012. Two thousand four hundred fifty-five donors who were between 5 and 48 years from the time of their donor surgery completed the questionnaire. RESULTS Eighty-four percent of donors were satisfied with their lives (scores ≥ 20 on the Satisfaction With Life Scale). Donors were at least as satisfied with their lives as previously reported general population samples. After adjusting for physical health, optimism, and demographics, donors' SWL was significantly associated with donors' recalled experience of donation. Social support and positive effects of the donation on relationships predicted greater SWL. Financial difficulties associated with donation and longer recovery times predicted lower SWL. Recipient outcomes were not significantly related to donor SWL. DISCUSSION Limitations include the lack of predonation SWL data, potential bias in postdonation SWL because of the situational context of the questionnaire, and a sample that is not representative of all U.S. living kidney donors. Nonetheless, strategies focused on improving the donation experience, particularly related to recovery time, financial issues, and social support, may result in greater SWL after donation.
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