title: Long-Term Non-End-Stage Renal Disease Risks After Living Kidney Donation.
abstract: Despite generally positive outcomes and high rates of satisfaction, living kidney donors are at risk for both medical and psychosocial problems. In this review, the authors summarize non-end-stage renal disease (ESRD) risks for donors and describe limitations to the data. We review the evidence of medical risks (e.g. increased cardiovascular disease and mortality, preeclampsia) and psychosocial risks (e.g. mood disturbance, financial burden). We then discuss the evidence of differential risks among subsets and the impact of postdonation events (e.g. development of diabetes). Collectively, available evidence indicates the following. (1) Recognizing the importance of non-ESRD risks has been overshadowed by analyses of the reported risk of ESRD. This imbalance should be remedied. (2) There is little quantification of the true contribution of donation to medical and psychosocial outcomes. (3) Most studies, to date, have been retrospective, with limited sample sizes and diversity and with less-than-ideal controls for comparison of outcomes. (4) Many postdonation events (diabetes and hypertension) can now be reasonably predicted, and their association with adverse outcomes can be quantified. (5) Mechanisms and systems need to be implemented to evaluate and care for donors who develop medical and/or psychosocial problems. (6) Costs to donors are a significant burden, and making donation financially neutral should be a priority.
authors.affiliation: Department of Surgery, University of Minnesota, Minneapolis, MN.
authors.forename: A J
authors.initials: AJ
authors.lastname: Matas
authors.affiliation: Transplant Clinic, Division of Transplantation, University of Wisconsin Hospital & Clinics, Madison, WI.
authors.forename: R E
authors.initials: RE
authors.lastname: Hays
authors.affiliation: Department of Medicine, University of Minnesota, Minneapolis, MN.
authors.forename: H N
authors.initials: HN
authors.lastname: Ibrahim
mesh_terms: D006801:Humans; D007674:Kidney Diseases / Q000209:etiology*; D016030:Kidney Transplantation / Q000379:methods*; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects*; D011183:Postoperative Complications; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*
keywords: clinical research/practice; donors and donation; donors and donation: donor follow-up; donors and donation: living; health services and outcomes research; kidney transplantation/nephrology