Minimizing morbidity of organ donation: analysis of factors for perioperative complications after living-donor nephrectomy in the United States.
BACKGROUND
Expansion of living kidney donation through liberalizing acceptance criteria invites a renewed focus on safety and outcomes. Wide variability exists in reported donor complications, and associated risk factors are ill defined. Use of administrative data can overcome the bias of single-center studies and identify variables associated with untoward events.


METHODS
The study population consisted of 3074 living kidney donors from 28 centers during 2004 and 2005. Data from a large healthcare registry were used to retrospectively identify the study cohort. Perioperative complications were identified using ICD-9-CM coding and classified according to the Clavien system. Logistic regression models were constructed to identify donor and center factors associated with complications.


RESULTS
There were no perioperative deaths. The overall complication rate was 10.6% and major complications defined by Clavien grade >or=3 was 4.2%. The prevalence of tobacco use, obesity, and hypertension, was 7.8%, 2.4%, and 2.3%, respectively. Age >50 (odds ratio [OR]=1.81, 95% confidence interval [95% CI]=1.25-2.61), tobacco use (OR=1.41, 95% CI=1.02-1.94), obesity (OR=1.92, 95% CI=1.06-3.46), and annual center volume <or=50 (OR=2.28, 95% CI=1.68-3.09), were significantly associated with overall morbidity, however only annual center volume <or=50 (OR=2.07, 95% CI=1.27-3.37) was significantly associated with a risk of major complications.


CONCLUSIONS
The inclusion of donors with tobacco abuse, obesity, and age >50 increases complications; however, the risk of major morbidity is small. Use of administrative data represents an important tool to facilitate the reconciliation of an increased need for organ donors with the concern for donor safety.
Patel
Siddharth
S
Division of Transplantation, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
Cassuto
James
J
Orloff
Mark
M
Tsoulfas
Georgios
G
Zand
Martin
M
Kashyap
Randeep
R
Jain
Ashok
A
Bozorgzadeh
Adel
A
Abt
Peter
P
D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007431:Intraoperative Complications / Q000453:epidemiology*; D019520:Living Donors / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009392:Nephrectomy; D016017:Odds Ratio; D011183:Postoperative Complications / Q000453:epidemiology*; D044469:Racial Groups; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States