Long-term medical risks to the living kidney donor.
Living kidney donation benefits recipients and society but carries short-term and long-term risks for the donor. This Review summarizes the studies that underlie our current understanding of these risks in the first decade after donation, with a view to improving the informed consent process. Two studies report a higher risk of end-stage renal disease (ESRD) among donors than among healthy nondonors; however, the absolute 15-year incidence of ESRD is <1%. All-cause mortality and the risk of cardiovascular events are similar among donors and healthy nondonors, although one study provides evidence for a 5% increase in all-cause mortality after 25 years that is attributable to donation. Some evidence suggests that the 20-year incidence of gout is slightly higher among donors than among healthy nondonors. The risks of gestational hypertension or pre-eclampsia seem to be 6% higher in pregnancies among donors than in pregnancies among healthy nondonors. The incidences of acute kidney injury, kidney stones that require surgical intervention, gastrointestinal bleeding and fractures seem no higher among donors than among healthy nondonors, although some of these conclusions are based on a small number of events. Future studies must clarify the lifetime incidence of long-term outcomes, particularly in relation to a donor's age, race, and history of comorbidities.
Department of Medicine, Division of Nephrology, Western University, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 4G5, Canada.
Ngan N
NN
Lam
Department of Internal Medicine, Division of Nephrology, Saint Louis University, 3635 Vista at Grand Boulevard, St. Louis, MO 63110, USA.
Krista L
KL
Lentine
Division of Nephrology, Tufts Medical Center, 800 Washington Street, Boston, MA 02111, USA.
Andrew S
AS
Levey
Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, MN 55414, USA.
Bertram L
BL
Kasiske
Department of Medicine, Division of Nephrology, Western University, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 4G5, Canada.
Amit X
AX
Garg
D058186:Acute Kidney Injury / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000209:etiology; D016030:Kidney Transplantation; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects*; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors