title: Perioperative Complications After Living Kidney Donation: A National Study.
abstract: We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14 964 living kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia-related injuries (2.4%), and "other" complications (6.6%). Major Clavien Classification of Surgical Complications grade IV or higher affected 2.5% of donors. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR 1.26, p = 0.001) and of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p < 0.0001), and grade IV or higher (aOR 1.56, p = 0.004) events. Other significant correlates of Clavien grade IV or higher events included obesity (aOR 1.55, p = 0.0005), predonation hematologic (aOR 2.78, p = 0.0002) and psychiatric (aOR 1.45, p = 0.04) conditions, and robotic nephrectomy (aOR 2.07, p = 0.002), while annual center volume >50 (aOR 0.55, p < 0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure, and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors.
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: K L
authors.initials: KL
authors.lastname: Lentine
authors.affiliation: Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
authors.forename: N N
authors.initials: NN
authors.lastname: Lam
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH.
authors.forename: D
authors.initials: D
authors.lastname: Axelrod
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: M A
authors.initials: MA
authors.lastname: Schnitzler
authors.affiliation: Division of Nephrology, Western University, London, Ontario, Canada.
authors.forename: A X
authors.initials: AX
authors.lastname: Garg
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: H
authors.initials: H
authors.lastname: Xiao
authors.affiliation: Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH.
authors.forename: N
authors.initials: N
authors.lastname: Dzebisashvili
authors.affiliation: Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH.
authors.forename: J D
authors.initials: JD
authors.lastname: Schold
authors.affiliation: Transplant Nephrology, Washington University School of Medicine, St. Louis, MO.
authors.forename: D C
authors.initials: DC
authors.lastname: Brennan
authors.affiliation: Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO.
authors.forename: H
authors.initials: H
authors.lastname: Randall
authors.affiliation: Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: E A
authors.initials: EA
authors.lastname: King
authors.affiliation: Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD.
authors.forename: D L
authors.initials: DL
authors.lastname: Segev
mesh_terms: D000328:Adult; D015897:Comorbidity; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D007902:Length of Stay; D019520:Living Donors; D008297:Male; D009392:Nephrectomy / Q000009:adverse effects*; D059035:Perioperative Period; D011183:Postoperative Complications / Q000209:etiology*; D012189:Retrospective Studies; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000379:methods*; D014481:United States