Depression diagnoses after living kidney donation: linking U.S. Registry data and administrative claims.
BACKGROUND
Limited data exist on correlates of psychological outcomes after kidney donation.


METHODS
We used a database integrating Organ Procurement and Transplantation Network registrations for 4650 living kidney donors from 1987 to 2007 with administrative data of a U.S. private health insurer (2000-2007 claims) to identify depression diagnoses among prior living donors. The burden and demographic correlates of depression after enrollment in the insurance plan were estimated by Cox regression. Graft failure and death of the donor's recipient were examined as time-varying exposures.


RESULTS
After start of insurance benefits, the cumulative frequency of depression diagnosis was 4.2% at 1 year and 11.5% at 5 years, and depression among donors was less common than among age- and gender-matched general insurance beneficiaries (rate ratio, 0.70; 95% confidence intervals [CI], 0.60-0.81). Demographic and clinical correlates of increased likelihood of depression diagnoses among the prior donors included female gender, white race, and some perioperative complications. After adjustment for donor demographic factors, recipient death (adjusted hazard ratio (aHR), 2.23; 95% CI, 1.11-4.48) and death-censored graft failure (aHR, 3.30; 95% CI, 1.49-7.34) were associated with two to three times the relative risk of subsequent depression diagnosis among nonspousal unrelated donors. There were trends toward increased depression diagnoses after recipient death and graft failure among spousal donors but no evidence of associations of these recipient events with the likelihood of depression diagnosis among related donors.


CONCLUSIONS
Recipient death and graft loss predict increased depression risk among unrelated living donors in this privately insured sample. Informed consent and postdonation care should consider the potential impact of recipient outcomes on the psychological health of the donor.
Saint Louis University Center for Outcomes Research, 3545 Lafayette Ave., St. Louis, MO 63104, USA. lentinek@slu.edu
Krista L
KL
Lentine
Mark A
MA
Schnitzler
Huiling
H
Xiao
David
D
Axelrod
Connie L
CL
Davis
Melanie
M
McCabe
Daniel C
DC
Brennan
Sheila
S
Leander
Amit X
AX
Garg
Amy D
AD
Waterman
D000328:Adult; D003863:Depression / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D006801:Humans; D007348:Insurance, Health; D016030:Kidney Transplantation; D019520:Living Donors / Q000523:psychology*; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D012042:Registries; D012086:Reoperation; D014481:United States