1
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Lauridsen MB, Skov K, Øzbay LA. Short-term Outcome of Danish Kidney Donors: Postoperative Complications and Labor Affiliation. Transplant Proc 2022; 54:1763-1767. [PMID: 35868874 DOI: 10.1016/j.transproceed.2022.05.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2022] [Accepted: 05/22/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND Living kidney donation is safe and effective, but disincentives to donation include risk of short- and long-term complications, which need to be addressed in order to ensure care of live kidney donors. METHODS From January 1, 2016 to December 31, 2019, 123 living kidney donors (LKDs) underwent LKD nephrectomy at Aarhus University Hospital, Aarhus, Denmark. Data from The Scandiatransplant registry and patient records were reviewed in order to identify short-term postoperative complications within 90 days after donation, as well as affiliation to the labor market and health data at follow-up. The Clavien-Dindo classification of surgical complications with modifications by Kocak et al was used to categorize minor and major complications. RESULTS There were available data for 119 of 123 LKDs. Of these, 25 (21%) developed minor complications and 4 (3%) developed major complications. Ninety LKDs (76%) had an uneventful course without any complications. The most common complications were pain and nausea that required additional medical treatment. Seventy-two of the 82 LKDs working before donation had returned to work within 3 months after donor nephrectomy. No one retired or became disabled as a result of being a live kidney donor. CONCLUSIONS Short-term follow up of the LKDs showed that most donors experienced an uneventful course and that the frequency of major complications was low. Donation did not seem to impact the ability to resume work. At the 90-day follow-up the majority of donors with both minor and major complications resumed work and reported full convalescence at the same level as donors without any complications. Nine of the LKDs (8%), all women, were out of work for >3 months with the main reason being fatigue.
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Affiliation(s)
| | - Karin Skov
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark
| | - Lara Aygen Øzbay
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.
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2
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Dayal C, Davies M, Diana NE, Meyers A. Living kidney donation in a developing country. PLoS One 2022; 17:e0268183. [PMID: 35536829 PMCID: PMC9089923 DOI: 10.1371/journal.pone.0268183] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 04/24/2022] [Indexed: 01/09/2023] Open
Abstract
Background
Living kidney donation has been advocated as a means to ameliorate the chronic shortage of organs for transplantation. Significant rates of comorbidity and familial risk for kidney disease may limit this approach in the local context; there is currently limited data describing living donation in Africa.
Methods
We assessed reasons for non-donation and outcomes following donation in a cohort of 1208 ethnically diverse potential living donors evaluated over a 32-year period at a single transplant centre in South Africa.
Results
Medical contraindications were the commonest reason for donor exclusion. Black donors were more frequently excluded (52.1% vs. 39.3%; p<0.001), particularly for medical contraindications (44% vs. 35%; p<0.001); 298 donors proceeded to donor nephrectomy (24.7%). Although no donor required kidney replacement therapy, an estimated glomerular filtration rate below 60 ml/min/1.73 m2 was recorded in 27% of donors at a median follow-up of 3.7 years, new onset albuminuria >300 mg/day was observed in 4%, and 12.8% developed new-onset hypertension. Black ethnicity was not associated with an increased risk of adverse post-donation outcomes.
Conclusion
This study highlights the difficulties of pursuing live donation in a population with significant medical comorbidity, but provides reassurance of the safety of the procedure in carefully selected donors in the developing world.
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Affiliation(s)
- Chandni Dayal
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
- * E-mail:
| | - Malcolm Davies
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Nina Elisabeth Diana
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
| | - Anthony Meyers
- Division of Nephrology, Department of Internal Medicine, University of the Witwatersrand, Johannesburg, South Africa
- National Kidney Foundation, Johannesburg, South Africa
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3
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Assessment of cognitive functioning after living kidney donation: A cross-sectional pilot study. PLoS One 2022; 17:e0264284. [PMID: 35213618 PMCID: PMC8880950 DOI: 10.1371/journal.pone.0264284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2021] [Accepted: 02/07/2022] [Indexed: 11/24/2022] Open
Abstract
Background Chronic kidney disease (CKD) has emerged as a risk factor for cognitive impairment. Living kidney donation results in reduction of the donors’ renal function. This is considered acceptable in general but possible associations with cognitive function have not yet been studied. Methods Sixty living kidney donors (LKD), who had donated between 2003 and 2012 at Hannover Medical School, underwent neurocognitive testing including attentional and memory testing. In a cross-sectional design results were compared with data of healthy controls (n = 40) and with norm data given in the respective test manuals adjusted for age, sex, and education. Results The median age of the LKD was 58 (range 39–70) years and the median time since donation was 7 (range 4–14) years. The LKD did not differ from controls in most of the cognitive test results and a composite attention test sum score. However, LKD did worse than controls in tests of working memory, parallel processing of stimuli, and sustained attention. No differences were found regarding quality of life. In LKD cognitive test results correlated significantly only with educational level but not with time since transplantation, eGFR, somatic comorbidity, quality of life and levels of fatigue, distress, depression, and anxiety. Conclusions Our data show a fairly normal performance of LKD in most attentional and memory tests. However, our pilot study also suggests some cognitive impairment in attention tests in LKD which would need to be confirmed in longitudinal prospective studies.
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Suwelack B, Berger K, Wolters H, Gerß J, Bormann E, Wörmann V, Burgmer M. Results of the prospective multicenter SoLKiD Cohort Study indicate bio-psycho-social outcome risks to kidney donors 12 months after donation. Kidney Int 2021; 101:597-606. [PMID: 34953772 DOI: 10.1016/j.kint.2021.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2021] [Revised: 11/10/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
The outcome after living kidney donation was assumed to be comparable to that of the general population. However, recent register studies reveal negative changes in kidney function, quality of life and fatigue. Avoiding methodological issues of previous studies, the Safety of the Living Kidney Donor (SoLKiD) cohort study analyzed the outcome of donors in a multicenter and interdisciplinary fashion. Donor data were collected pre-donation and two-, six- and 12-months post-donation in 20 German transplantation centers. Primary parameters were kidney function, quality of life, and fatigue. Secondary endpoints were blood pressure, hemoglobin, hemoglobin A1c, body mass index, depression and somatization. Parameters were analyzed with non-parametric statistical tests and a mixed model regression for changes in time, their clinical relevance and interaction encompassing 336 donors with mean age of 52 years. Most of the physical secondary parameters, depression, and quality of life showed little or no changes and regained their pre-donation level. Kidney function decreased significantly with a 37% loss of glomerular filtration rate and an increase of donors with chronic kidney disease stage 3 from 1.5% pre-donation to about 50%. Donors consistently showed increased fatigue and somatization. Mental fatigue increased from 10.6% to 28.1%. The main influencing factors for decreased kidney function and increased fatigue were their respective pre-donation levels, and donor age for kidney function and subject stress level in fatigue. Thus, our study showed that a significant number of donors developed clinically relevant changes in physical and mental health and emphasizes the urgent need to inform potential donors about these risks.
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Affiliation(s)
- Barbara Suwelack
- Department of Medicine D, Transplantnephrology, University Hospital of Münster, Westphalian Wilhelms University Münster, Germany.
| | - Klaus Berger
- Institute of Epidemiology and Social Medicine, Westphalian Wilhelms University Münster, Germany
| | - Heiner Wolters
- Department of General and Visceral Surgery University Hospital of Münster, Westphalian Wilhelms University Münster, Germany
| | - Joachim Gerß
- Institute of Biostatistics and Clinical Research, Westphalian Wilhelms University Münster, Germany
| | - Eike Bormann
- Institute of Biostatistics and Clinical Research, Westphalian Wilhelms University Münster, Germany
| | - Viktorya Wörmann
- Department of Psychosomatics and Psychotherapy, LWL Hospital Münster and University Hospital of Münster, Westphalian Wilhelms University Münster, Germany
| | - Markus Burgmer
- Department of Psychosomatics and Psychotherapy, LWL Hospital Münster and University Hospital of Münster, Westphalian Wilhelms University Münster, Germany
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5
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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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6
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Plage H, Pielka P, Liefeldt L, Budde K, Ebbing J, Sugünes N, Miller K, Cash H, Bichmann A, Sattler A, Kotsch K, Friedersdorff F. Extended Criteria Donors in Living Kidney Transplantation Including Donor Age, Smoking, Hypertension and BMI. Ther Clin Risk Manag 2020; 16:787-793. [PMID: 32922016 PMCID: PMC7455534 DOI: 10.2147/tcrm.s256962] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Accepted: 06/14/2020] [Indexed: 12/02/2022] Open
Abstract
Purpose An expansion of selection criteria for deceased organ transplantation already exists to manage the current donor shortage. Comparable evaluation of risk factors for living donors should be investigated to improve this issue. Patients and Methods Our retrospective single-centre study analysed 158 patients with living kidney transplants performed between February 2006 and June 2012. We investigated the influence of donor risk factors (RF) including body mass index over 30 kg/m2, age >60 years, active nicotine abuse and arterial hypertension on postoperative kidney function with focus on the recipients. This was measured for long-term survival and glomerular filtration rate (GFR) in a 5-year follow-up. Results Overall, out of 158 living donors, 84 donors were identified to have no risk factors, whereas 74 donors had at least one risk factor. We noted a significant higher delayed graft function (p=0.042) in the first 7 days after transplantation, as well as lower GFR of recipients of allografts with risk factors in the first-year after transplantation. In our long-term results, there was no significant difference in the functional outcome (graft function, recipient and graft survival) between recipients receiving kidneys from donors with no and at least one risk factors. In the adjusted analysis of subgroups of different risk factors, recipients of donors with “age over 60 years” at time of transplantation had a decreased transplant survival (p=0.014). Conclusion Thus, a careful expansion for selection criteria for living donors with critical evaluation could be possible, but especially the age of the donors could be a limited risk factor.
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Affiliation(s)
- Henning Plage
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Poline Pielka
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Jan Ebbing
- Department of Urology, University Hospital Basel, Urological University Clinic Basel-Liestal, Basel, Switzerland
| | - Nesrin Sugünes
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Anna Bichmann
- Department of Anaesthesia and Operative Intensive Care Medicine, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Arne Sattler
- Department of General, Visceral- and Vascular Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Kotsch
- Department of General, Visceral- and Vascular Surgery, Charité -Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
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7
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Long-term prognosis after kidney donation: a propensity score matched comparison of living donors and non-donors from two population cohorts. Eur J Epidemiol 2020; 35:699-707. [PMID: 32440788 PMCID: PMC7387377 DOI: 10.1007/s10654-020-00647-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2020] [Accepted: 05/06/2020] [Indexed: 01/22/2023]
Abstract
Background Live donor nephrectomy is a safe procedure. However, long-term donor prognosis is debated, necessitating high-quality studies. Methods A follow-up study of 761 living kidney donors was conducted, who visited the outpatient clinic and were propensity score matched and compared to 1522 non-donors from population-based cohort studies. Primary outcome was kidney function. Secondary outcomes were BMI (kg/m2), incidences of hypertension, diabetes, cardiovascular events, cardiovascular and overall mortality, and quality of life. Results Median follow-up after donation was 8.0 years. Donors had an increase in serum creatinine of 26 μmol/l (95% CI 24–28), a decrease in eGFR of 27 ml/min/1.73 m2 (95% CI − 29 to − 26), and an eGFR decline of 32% (95% CI 30–33) as compared to non-donors. There was no difference in outcomes between the groups for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and mortality. A lower risk of new-onset hypertension (OR 0.45, 95% CI 0.33–0.62) was found among donors. The EQ-5D health-related scores were higher among donors, whereas the SF-12 physical and mental component scores were lower. Conclusion Loss of kidney mass after live donation does not translate into negative long-term outcomes in terms of morbidity and mortality compared to non-donors. Trial registration Dutch Trial Register NTR3795. Electronic supplementary material The online version of this article (10.1007/s10654-020-00647-y) contains supplementary material, which is available to authorized users.
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8
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Rodrigue JR, Fleishman A, Schold JD, Morrissey P, Whiting J, Vella J, Kayler LK, Katz DA, Jones J, Kaplan B, Pavlakis M, Mandelbrot DA. Patterns and predictors of fatigue following living donor nephrectomy: Findings from the KDOC Study. Am J Transplant 2020; 20:181-189. [PMID: 31265199 DOI: 10.1111/ajt.15519] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 05/23/2019] [Accepted: 06/11/2019] [Indexed: 01/25/2023]
Abstract
This study sought to identify the prevalence, pattern, and predictors of clinical fatigue in 193 living kidney donors (LKDs) and 20 healthy controls (HCs) assessed at predonation and 1, 6, 12, and 24 months postdonation. Relative to HCs, LKDs had significantly higher fatigue severity (P = .01), interference (P = .03), frequency (P = .002), and intensity (P = .01), and lower vitality (P < .001), at 1-month postdonation. Using published criteria, significantly more LKDs experienced clinical fatigue at 1 month postdonation, compared to HCs, on both the Fatigue Symptom Inventory (60% vs. 37%, P < .001) and SF-36 Vitality scale (67% vs. 16%, P < .001). No differences in fatigue scores or clinical prevalence were observed at other time points. Nearly half (47%) reported persistent clinical fatigue from 1 to 6 months postdonation. Multivariable analyses demonstrated that LKDs presenting for evaluation with a history of affective disorder and low vitality, those with clinical mood disturbance and anxiety about future kidney failure after donation, and those with less physical activity engagement were at highest risk for persistent clinical fatigue 6 months postdonation. Findings confirm inclusion of fatigue risk in existing OPTN informed consent requirements, have important clinical implications in the care of LKDs, and underscore the need for further scientific examination in this population.
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Affiliation(s)
- James R Rodrigue
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Aaron Fleishman
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts
| | - Jesse D Schold
- Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio
| | - Paul Morrissey
- Transplant Center, Rhode Island Hospital, Providence, Rhode Island
| | - James Whiting
- Maine Transplant Center, Maine Medical Center, Portland, Maine
| | - John Vella
- Maine Transplant Center, Maine Medical Center, Portland, Maine
| | - Liise K Kayler
- Montefiore Einstein Center for Transplantation, Bronx, New York.,Regional Center of Excellence for Transplantation & Kidney Care, Erie County Medical Center, University of Buffalo, Buffalo, New York
| | - Daniel A Katz
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Jody Jones
- Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, Iowa
| | - Bruce Kaplan
- Department of Medicine, University of Arizona, Tucson, Arizona.,School for the Science of Health Care Delivery, Arizona State University, Phoenix, Arizona
| | - Martha Pavlakis
- The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
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9
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Sichez PC, Baboudjian M, Depalorte V, Karsenty G, Lechevallier É, Boissier R. [Long term renal function outcomes and predictive factors of chronic renal failure after living kidney donation]. Prog Urol 2019; 29:496-503. [PMID: 31383507 DOI: 10.1016/j.purol.2019.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2019] [Revised: 06/23/2019] [Accepted: 07/02/2019] [Indexed: 11/15/2022]
Abstract
INTRODUCTION Living donor kidney transplants give the best results in term of renal function and are the principal solutions for the transplant shortage. However, donors selection and kidney function evaluation after surgery are essential. The objective of this study was to evaluate the prevalence and to identify the predictive factors of chronic renal failure for the donor, after living donor nephrectomy. MATERIALS AND METHODS It was a retrospective and monocentric study, including all the patients who underwent a living donor nephrectomy from 2007 to 2015 at the hospital of the Conception in Marseille. The primary study endpoint was renal function mesured by the glomerular filtration rate (GFR in mL/min) at 1 year and 5 years after surgery. The identification of moderate kidney failure predictive factors was achieved by an univariate and a multivariate analysis under Cox model. RESULTS Ninety-one patients were included. There was 40,7 % of men and media nage was 49 years (21; 70). Median pre-operative GFR was 94mL/min (67; 160). Median follow-up was 24 months (1; 120). Post operative GFR at 1 month, 1 year and 5 years was respectively 63mL/min (33; 90), 65mL/min (38; 107) and 67mL/min (56; 126) ans significantly lower than pre operative GFR (respectively P<0,001, P<0,001 et P=0,005). The prevalence of moderate kidney failure at 1 month, 1 year and 5 years was respectively 43,1 %, 33,3 % ans 25 %. In univariate and multivariate analysis, the only parametre significantly associated with a 1 year GFR>60mL/min wasp re operative GFR>90mL/min OR 3,61 IC95 % (1,27; 10,28) P=0,02. CONCLUSION Living donor nephrectomy leads to an important medium to long term loss of renal function. Donors with pre operative GFR<90mL/min should benefit from a rigorous supervision and nephrological care. LEVEL OF EVIDENCE 3.
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Affiliation(s)
- P C Sichez
- Service du Pr Lechevallier, Hôpital de la Conception, 147, Bd Baille 13005 Marseille, France.
| | - M Baboudjian
- Service du Pr Lechevallier, Hôpital de la Conception, 147, Bd Baille 13005 Marseille, France.
| | - V Depalorte
- Service du Pr Lechevallier, Hôpital de la Conception, 147, Bd Baille 13005 Marseille, France.
| | - G Karsenty
- Service du Pr Lechevallier, Hôpital de la Conception, 147, Bd Baille 13005 Marseille, France.
| | - É Lechevallier
- Service du Pr Lechevallier, Hôpital de la Conception, 147, Bd Baille 13005 Marseille, France.
| | - R Boissier
- Service du Pr Lechevallier, Hôpital de la Conception, 147, Bd Baille 13005 Marseille, France.
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10
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Broers NJH, Fung TY, Kooman JP, Christiaans MHL. Living-donor transplantation leads to a major improvement in physical functioning: an observational study on the impact on potential donors and their recipients. BMC Nephrol 2019; 20:109. [PMID: 30922268 PMCID: PMC6440145 DOI: 10.1186/s12882-019-1299-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 03/17/2019] [Indexed: 12/27/2022] Open
Abstract
Background Prospective studies combining physical functioning (PF), physical activity (PA), and body composition (BC) after living donor transplantation/donation are scarce. We aimed to study differences in these parameters between kidney transplant recipients and their living donors by examining changes in these parameters in the first post-operative year in both groups. Methods Twenty-two kidney transplant recipients and 22 healthy kidney donors were included in this prospective longitudinal study with a follow-up until twelve months. PF was assessed by handgrip strength (HGS), and by the physical domains of health-related quality of life (HRQOL) using the Short Form-36 questionnaire [PF (SF-36 PF) and physical component summary (PCS) score]. BC was measured by the Body Composition Monitor©, and PA was measured by the SenseWear™ pro3. Results At baseline, recipients had significantly lower HGS (after adjustment for sex and body weight), SF-36 PF, PCS, and PA, as compared with their donors. In recipients HGS significantly increased in the first year after transplantation, but PA did not change in the first six months after transplantation. Furthermore, no significant increase in lean tissue mass was observed. For healthy donors no significant changes in these parameters were observed, with exception of SF-36 PF, which declined in the first three months after donation, but equaled baseline values after twelve months. Conclusion Recipients showed impressive improvements in PF and the physical domains of HRQOL in the first year after transplantation, reaching levels of healthy kidney donors already three to six months after transplantation. On the contrary, living kidney donation did not show any deterioration of the investigated parameters, supporting little impact for well-screened donors, while there is high benefit for transplant recipients.
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Affiliation(s)
- Natascha J H Broers
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands. .,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands.
| | - Tsz Yeung Fung
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands
| | - Jeroen P Kooman
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
| | - Maarten H L Christiaans
- Department of Internal Medicine, Division of Nephrology, Maastricht University Medical Center+, PO Box 5800, 6202 AZ, Maastricht, The Netherlands.,NUTRIM School of Nutrition and Translational Research in Metabolism, Maastricht University, Maastricht, The Netherlands
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11
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Zorgdrager M, van Londen M, Westenberg LB, Nieuwenhuijs-Moeke GJ, Lange JFM, de Borst MH, Bakker SJL, Leuvenink HGD, Pol RA. Chronic pain after hand-assisted laparoscopic donor nephrectomy. Br J Surg 2019; 106:711-719. [PMID: 30919435 PMCID: PMC6593841 DOI: 10.1002/bjs.11127] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 12/18/2018] [Accepted: 01/03/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND Data on chronic pain after kidney donation are sparse. The aim of this study was to assess the incidence of chronic pain after hand-assisted laparoscopic nephrectomy. METHODS Living kidney donors who donated between 2011 and 2017 at the University Medical Centre Groningen were included. All patients underwent hand-assisted laparoscopic donor nephrectomy. Postdonation pain and movement disabilities were assessed using the Carolinas Comfort Scale (CCS) and a visual analogue scale (VAS). The prevalence, severity of pain and the need for analgesics were reported. RESULTS Some 333 living kidney donors with a mean age of 56 years were included. At a median of 19 (i.q.r. 10-33) months after donation, 82 donors (24·6 per cent) had a CCS score above 0, of which 58 (71 per cent) had a CCS score of at least 2 and 57 (70 per cent) reported movement limitations. Some 110 donors (33·0 per cent) had a VAS score of more than 0. Complaints mainly occurred during bending over (12·3 per cent) and exercising (12·4 per cent). Thirty-two donors (9·7 per cent) required analgesics during follow-up between donation and the time of measurement, and six of 82 (7 per cent) reported chronic inguinal pain. In multivariable analysis, donor age (odds ratio (OR) 0·97, 95 per cent c.i. 0·95 to 0·99; P = 0·020) and length of hospital stay (OR 1·21, 1·01 to 1·51; P = 0·041) were independently associated with chronic pain. CONCLUSION One-quarter of donors experienced chronic postdonation pain or discomfort, most of which was bothersome. Younger donors and those with a longer postoperative hospital stay had more symptoms.
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Affiliation(s)
- M Zorgdrager
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M van Londen
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - L B Westenberg
- Department of Radiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - G J Nieuwenhuijs-Moeke
- Department of Anaesthesiology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - J F M Lange
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - M H de Borst
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - S J L Bakker
- Department of Internal Medicine, Division of Nephrology, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - H G D Leuvenink
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
| | - R A Pol
- Department of Surgery, Division of Transplant Surgery, University Medical Centre Groningen, University of Groningen, Groningen, the Netherlands
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12
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Karahan M, Yildirim M, Kucuk HF, Turunc V, Demir H, Salturk C, Yavuz A, Demir T, Ari E. Oxidative DNA Damage Is Increased in Living Kidney Donors. Transplant Proc 2019; 51:1049-1053. [PMID: 31101169 DOI: 10.1016/j.transproceed.2019.02.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 02/16/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Long-term consequences of donor nephrectomy might be reduced kidney function, increased risk for cardiovascular disease, and impaired quality of life. The purpose of the current cross-sectional study was to evaluate the relationship between clinical, laboratory, and donation-specific outcomes of living kidney donors and systemic oxidative DNA damage. METHODS We conducted a cross-sectional study and assessed retrospectively pre- and postdonation data from 60 donors who donated between 2010 and 2015. Plasma malondialdehyde levels and 8-hydroxy-2'-deoxyguanosine/deoxyguanosine ratio (8-OHdG/dG ratio) were determined as oxidative stress markers. Catalase, carbonic anhydrase, and paraoxonase (PON) activities were measured as antioxidants. RESULTS Approximately 3 years after donation, the hypertensive donor ratio was 12%, and 11% of the donors had glomerular filtration rate <60 mL/min/1.73 m2. Mean serum urea (P = .001) and serum creatinine levels (P = .001) were increased; creatinine clearance level (126.2 ± 35.5 vs 94.6 ± 26.8, P = .001) was decreased in the postdonation period. There was a significant positive correlation between predonation serum urea and 8-0HdG/dG ratio (r = 0.338, P = .016) and predonation serum creatinine and 8-0HdG/dG ratio (r = 0.442, P = .001), while there was a significant negative correlation between serum creatinine and PON activity (r = -0.545, P < .001). CONCLUSION Our data have demonstrated that kidney donors exhibit increased oxidative DNA damage and decreased antioxidant activity. We propose that predonation serum creatinine is positively correlated with 8-0HdG/dG ratio and negatively correlated with antioxidant PON activity. This is the first study to demonstrate that plasma oxidative DNA damage increases in healthy kidney donors.
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Affiliation(s)
- M Karahan
- Department of General Surgery, Kartal Training Hospital, Istanbul, Turkey
| | - M Yildirim
- Department of Transplantation, Kartal Training Hospital, Istanbul, Turkey
| | - H F Kucuk
- Department of Transplantation, Kartal Training Hospital, Istanbul, Turkey
| | - V Turunc
- Bahcesehir University, Department of General Surgery, Istanbul, Turkey
| | - H Demir
- Department of Biochemistry, Yuzuncu Yil University, Van, Turkey
| | - C Salturk
- Department of Chest Diseases, Yeniyuzyil University, Istanbul, Turkey
| | - A Yavuz
- Department of Nephrology, Tekirdag State Hospital, Tekirdag, Turkey
| | - T Demir
- Department of Transplantation, Kartal Training Hospital, Istanbul, Turkey
| | - E Ari
- Bahcesehir University, Department of Nephrology, Istanbul, Turkey.
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13
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Sommerer C, Estelmann S, Metzendorf NG, Leuschner M, Zeier M. Gender disparity in health-related quality of life and fatigue after living renal donation. BMC Nephrol 2018; 19:377. [PMID: 30587146 PMCID: PMC6307222 DOI: 10.1186/s12882-018-1187-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2018] [Accepted: 12/14/2018] [Indexed: 01/24/2023] Open
Abstract
Background The clinical outcome and health-related quality of life (HRQoL) of living kidney donors is mostly not detrimental, but some donors experience impairment after donation. Gender-specific effects of living kidney donors was evaluated. Methods Clinical outcome was assessed in living kidney donors and HRQoL was obtained by self-reporting validated test systems as the Multidimensional Fatigue Inventory (MFI-20), the Short Form 36 (SF-36), and the Patient Health Questionnaire (PHQ-9). Results Two hundred and eleven (211) living renal donors were evaluated (female 62.2%). Response rate was 80.8%. In both genders, a decrease of renal function of 26% was observed after donation. De novo antihypertensives were introduced in 28.3% of women and 36.5% of men. HRQoL was comparable in female and male donors, except for mental HRQoL, which was lower in 51- to 60-year-old female donors, compared to age-matched male donors and to the female general population. Female donors aged 40–59 years demonstrated more fatigue than the age-matched general population. A low mental HRQoL (MCS; SF-36) was associated with higher values for fatigue (General Fatigue Score; MFI-20) in both genders. Multiple regression analysis detected the General Fatigue score of the MFI-20 questionnaire and depression identified by the PHQ-9 score as independent variables predicting MCS of the SF-36 in both genders. Lower age at time of donation contributed to a lower MCS in female donors. Conclusions Overall, HRQoL in living kidney donors exceeds that of the general population. Inferior mental health status and fatigue seem to be a problem, especially in middle-aged female donors, but not in all female donors. Psychological evaluation pre donation and psychological support post donation are required. Electronic supplementary material The online version of this article (10.1186/s12882-018-1187-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Claudia Sommerer
- Division of Nephrology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Germany.
| | - Sarah Estelmann
- Division of Nephrology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Germany
| | - Nicole G Metzendorf
- Division of Nephrology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Germany
| | - Maren Leuschner
- Department of General Internal and Psychosomatic Medicine, University Hospital Heidelberg, Im Neuenheimer Feld 410, D-69120, Heidelberg, Germany
| | - Martin Zeier
- Division of Nephrology, Medical University Hospital Heidelberg, Im Neuenheimer Feld 162, 69120, Heidelberg, Germany
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Kezić A, Kovačević S, Marinković J, Ristić S, Radivojević D, Blagojević-Lazić R, Djukanovic L, Ležaić VD. Comparison of accepted and unaccepted living kidney donors: one-center experience. Ren Fail 2018; 40:152-159. [PMID: 29575953 PMCID: PMC6014375 DOI: 10.1080/0886022x.2018.1450758] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 11/30/2017] [Accepted: 03/06/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Kidney transplantation from living donors (LD) has stagnated in many countries. This study aimed to check whether correction of LD selection practice could increase the number of kidney transplantations. METHODS From January 2003 to December 2012, 241 potential adult LD were evaluated in our hospital. Outcome (mortality and end-stage renal disease-ESRD) of accepted LD (182) was compared with unaccepted (59) donors. RESULTS Mortality of LD was comparable with that for the standardized Serbian population (SMR = 1.104; 95% CI (0.730-1.606). Among evaluated potential LD, almost every fourth had been unaccepted, but reasons were modifiable in 42.4% of them. In pre-donation period unaccepted donors were significantly older, measured glomerular filtration rate was lower, with higher 15-year and lifelong projected ESRD risks than accepted donors. Despite this, ten years outcome of both groups LD was similar: none of LD developed ESRD, 9.8% of accepted and 11.8% of unaccepted LD died (p = .803). CONCLUSIONS During an average of 101 months of follow-up mortality of accepted LD did not differ significantly as compared to the age standardized Serbian population and none of them developed ESRD. In examination of potential LD, the use of accurate and precise methods for kidney function estimation and the evaluation of risk for ESRD and mortality as well as treatment of modifiable contraindications for kidney donation are necessary.
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Affiliation(s)
- Aleksandra Kezić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | - Stojanka Ristić
- Department of Nephrology, Clinical Centre of Serbia, Belgrade, Serbia
| | | | | | | | - Visnja D. Ležaić
- School of Medicine, University of Belgrade, Belgrade, Serbia
- Department of Nephrology, Clinical Centre of Serbia, Belgrade, Serbia
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15
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Follow-up Status of Living Kidney Donors After Transplantation. Transplant Proc 2018; 50:2346-2349. [PMID: 30316355 DOI: 10.1016/j.transproceed.2018.03.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2018] [Accepted: 03/06/2018] [Indexed: 11/23/2022]
Abstract
BACKGROUND The purpose of this study was to identify the follow-up status of living kidney donors after transplantation. METHODS This study was a secondary analysis of the medical record data from one hospital in Korea. Eighty-one donors from February 2010 to April 2016 were selected for analysis of follow-up status. Data were analyzed using descriptive statistics, Kaplan-Meier estimator, and Cox regression. RESULTS Overall, 48.4% of donors continued to participate in follow-up visits. Donor follow-up rates at 1, 2, and 3 years were 75.1%, 58.2%, and 48.4%, respectively. Significant predictors of follow-up loss among donors were smoking habit and the type of follow-up health care provider. CONCLUSION For management of the physical and psychological health of donors, continuous care by the nephrologist and surgeon is required following transplantation.
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16
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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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17
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Gritsch HA. Adrenal Function After Laparoscopic Nephrectomy: The Zurich Clinical Trial. Eur Urol Focus 2018; 4:144-145. [PMID: 29779841 DOI: 10.1016/j.euf.2018.05.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2018] [Revised: 04/19/2018] [Accepted: 05/03/2018] [Indexed: 10/16/2022]
Abstract
This manuscript reviews the outcomes of a European clinical trial to evaluate the effects of living kidney donation on adrenal function. The study shows that left-sided donor nephrectomy is associated with transiently reduced adrenocortical responsiveness, which returns to baseline after 28 d.
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Affiliation(s)
- Hans Albin Gritsch
- David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
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18
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Yalin SF, Trabulus S, Seyahi N, Cengiz M, Cicik ME, Altiparmak MR. Ambulatory blood pressure monitoring in living kidney donors: What changes in 10 years? Clin Transplant 2018; 32:e13224. [PMID: 29457269 DOI: 10.1111/ctr.13224] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/11/2018] [Indexed: 11/30/2022]
Abstract
In renal transplantation, living donations have more significant benefits compared to cadaveric donations. However, a probable increase in blood pressure following donation should also be kept in mind. In this study, we investigated the long-term changes in blood pressure in living kidney donors using ambulatory blood pressure monitoring and we explored the e-GFR and albuminuria/proteinuria measurements at 3 time points. Twenty-eight living kidney donors and 39 healthy individuals were evaluated and compared at the baseline and later at the 10th year. At the 10th year, creatinine levels were higher and eGFR levels were lower in the donors, whereas the systolic and diastolic measurements of the donors and controls and the prevalence of nondipping in the donors and controls were similar. Our study may be underpowered due to its small population size. However, our results at the 10th year follow-up indicated that the risk of hypertension might not seem to have increased in the well-selected donors. In addition, the majority of our donors had preserved their GFR values. Therefore, we can suggest that living kidney donation appears to be safe in well-selected patients over a 10-year time frame.
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Affiliation(s)
- Serkan Feyyaz Yalin
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Sinan Trabulus
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Nurhan Seyahi
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mahir Cengiz
- Department of Internal Medicine, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mustafa Erdogan Cicik
- Department of Ophthalmology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Mehmet Riza Altiparmak
- Department of Nephrology, Cerrahpasa Faculty of Medicine, Istanbul University, Istanbul, Turkey
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19
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Yildirim M, Karahan M, Kucuk H, Demir T, Demir H, Turan H, Yavuz A, Ari E. Increased Oxidative Stress in Living Kidney Donors: Correlation of Renal Functions With Antioxidant Capacity. Transplant Proc 2017; 49:407-410. [DOI: 10.1016/j.transproceed.2017.01.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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20
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Janki S, Dols LFC, Timman R, Mulder EEAP, Dooper IMM, van de Wetering J, IJzermans JNM. Five-year follow-up after live donor nephrectomy - cross-sectional and longitudinal analysis of a prospective cohort within the era of extended donor eligibility criteria. Transpl Int 2016; 30:266-276. [PMID: 27717017 DOI: 10.1111/tri.12872] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2016] [Revised: 08/10/2016] [Accepted: 09/30/2016] [Indexed: 01/08/2023]
Abstract
To establish the outcome of live kidney donors 5 years after donation, we investigated the risk for progressive renal function decline and quality of life (QoL). Data on estimated glomerular filtration rate (eGFR), creatinine, hypertension, QoL and survival were assessed in a prospective cohort of 190 donors, who donated between 2008 and 2010. Data were available for >90%. The mean age predonation was 52.8 ± 11.5 years, 30 donors having pre-existent hypertension. The mean follow-up was 5.1 ± 0.9 years. Eight donors had died due to non-donation-related causes. After 5 years, the mean eGFR was 60.2 (95% CI 58.7-62.7) ml/min/1.73 m2 , with a median serum creatinine of 105.1 (95% CI 102.5-107.8) μmol/l. eGFR decreased to 33.6% and was longitudinally lower among men than women and declining with age (P < 0.001), without any association on QoL. Donors with pre-existent and new-onset hypertension demonstrated no progressive decline of renal function overtime compared to nonhypertensives. No donors were found with proteinuria, microalbuminuria or at risk for end-stage renal disease. After an initial decline postdonation, renal function remained unchanged overtime. Men and ageing seem to affect renal function overtime, while decreased renal function did not affect QoL. These data support further stimulation of living kidney donation programmes as seen from the perspective of donor safety.
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Affiliation(s)
- Shiromani Janki
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Leonienke F C Dols
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Reinier Timman
- Department of Psychiatry, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Evalyn E A P Mulder
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
| | - Ine M M Dooper
- Department of Nephrology, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Jan N M IJzermans
- Department of Surgery, Erasmus MC University Medical Center, Rotterdam, The Netherlands
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22
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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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24
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Nazarian SM, Reese PP. Insights from a ten-year, prospective study of live kidney donors. Transpl Int 2015; 28:1265-7. [PMID: 26046584 DOI: 10.1111/tri.12618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Accepted: 06/01/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Susanna M Nazarian
- Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA
| | - Peter P Reese
- Department of Biostatistics and Epidemiology, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA.,Leonard Davis Institute of Health Economics, University of Pennsylvania, Philadelphia, PA, USA.,Renal-Electrolyte and Hypertension Division, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA, USA
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