Comorbidity burden and perioperative complications for living kidney donors in the United States.
OBJECTIVE
Since 1998, 35% of kidney transplants in the United States have been derived from living donors. Research suggests minimal long-term health consequences after donation, but comprehensive studies are limited. The primary objective was to evaluate trends in comorbidity burden and complications among living donors.


METHODS
The National Inpatient Sample (NIS) was used to identify donors from 1998 to 2010 (n=69,117). Comorbid conditions, complications, and length of stay during hospitalization were evaluated. Outcomes among cohorts undergoing appendectomies, cholecystectomies and nephrectomy for nonmetastatic carcinoma were compared, and sample characteristics were validated with the Scientific Registry of Transplant Recipients (SRTR). Survey regression models were used to identify risk factors for outcomes.


RESULTS
The NIS captured 89% (69,117 of 77,702) of living donors in the United States. Donor characteristics were relatively concordant with those noted in SRTR (mean age, 40.1 versus 40.3 years [P=0.18]; female donors, 59.0% versus 59.1% [P=0.13]; white donors, 68.4% versus 69.8% [P<0.001] for NIS versus SRTR). Incidence of perioperative complications was 7.9% and decreased from 1998 to 2010 (from 10.1% to 7.6%). Men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 1.20 to 1.56) and donors with hypertension (AOR, 3.35; 95% CI, 2.24 to 5.01) were more likely to have perioperative complications. Median length of stay declined over time (from 3.7 days to 2.5 days), with longer length of stay associated with obesity, depression, hypertension, and pulmonary disorders. Presence of depression (AOR, 1.08; 95% CI, 1.04 to 1.12), hypothyroidism (AOR, 1.07; 95% CI, 1.04 to 1.11), hypertension (AOR, 1.38; 95% CI, 1.27 to 1.49), and obesity (AOR, 1.07; 95% CI, 1.03 to 1.11) increased over time. Complication rates and length of stay were similar for patients undergoing appendectomies and cholecystectomies but were less than those with nephrectomies for carcinoma.


CONCLUSIONS
The NIS is a representative sample of living donors. Complications and length of stay after donation have declined over time, while presence of documented comorbid conditions has increased. Patients undergoing appendectomy and cholecystectomy have similar outcomes during hospitalization. Monitoring the health of living donors remains critically important.
Department of Quantitative Health Sciences,, ‡Glickman Urological and Kidney Institute, and, §Digestive Disease Institute, Cleveland Clinic, Cleveland, Ohio;, †Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, ‖The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Jesse D
JD
Schold
David A
DA
Goldfarb
Laura D
LD
Buccini
James R
JR
Rodrigue
Didier A
DA
Mandelbrot
Emily L G
EL
Heaphy
Richard A
RA
Fatica
Emilio D
ED
Poggio
D000328:Adult; D000368:Aged; D015897:Comorbidity; D005260:Female; D006801:Humans; D016030:Kidney Transplantation / Q000009:adverse effects*; D007902:Length of Stay; D019520:Living Donors; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D059035:Perioperative Period; D011183:Postoperative Complications / Q000453:epidemiology*