title: Minimizing morbidity of organ donation: analysis of factors for perioperative complications after living-donor nephrectomy in the United States.
abstract: 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.
authors.affiliation: Division of Transplantation, Department of Surgery, University of Rochester Medical Center, Rochester, NY, USA.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Patel
authors.forename: James
authors.initials: J
authors.lastname: Cassuto
authors.forename: Mark
authors.initials: M
authors.lastname: Orloff
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsoulfas
authors.forename: Martin
authors.initials: M
authors.lastname: Zand
authors.forename: Randeep
authors.initials: R
authors.lastname: Kashyap
authors.forename: Ashok
authors.initials: A
authors.lastname: Jain
authors.forename: Adel
authors.initials: A
authors.lastname: Bozorgzadeh
authors.forename: Peter
authors.initials: P
authors.lastname: Abt
mesh_terms: 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