title: Long-term risks of kidney living donation: review and position paper by the ERA-EDTA DESCARTES working group.
abstract: Two recent matched cohort studies from the USA and Norway published in 2014 have raised some concerns related to the long-term safety of kidney living donation. Further studies on the long-term risks of living donation have since been published. In this position paper, Developing Education Science and Care for Renal Transplantation in European States (DESCARTES) board members critically review the literature in an effort to summarize the current knowledge concerning long-term risks of kidney living donation to help physicians for decision-making purposes and for providing information to the prospective live donors. Long-term risk of end-stage renal disease (ESRD) can be partially foreseen by trying to identify donors at risk of developing ‘de novo’ kidney diseases during life post-donation and by predicting lifetime ESRD risk. However, lifetime risk may be difficult to assess in young donors, especially in those having first-degree relatives with ESRD. The study from Norway also found an increased risk of death after living donor nephrectomy, which became visible only after >15 years of post-donation follow-up. However, these findings are likely to be largely the result of an overestimation due to the confounding effect related to a family history of renal disease. DESCARTES board members emphasize the importance of optimal risk–benefit assessment and proper information to the prospective donor, which should also include recommendations on health-promoting behaviour post-donation.
authors.affiliation: Department of Nephrology, Azienda Ospedaliero-Universitaria di Parma, Parma, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Maggiore
authors.affiliation: Department of Nephrology, Charité Medical University Berlin, Berlin, Germany.
authors.forename: Klemens
authors.initials: K
authors.lastname: Budde
authors.affiliation: Department of Nephrology, Technical University of Munich, Munich, Germany.
authors.forename: Uwe
authors.initials: U
authors.lastname: Heemann
authors.affiliation: Department of Nephrology, Radboud University Medical Centre, Nijmegen, The Netherlands.
authors.forename: Luuk
authors.initials: L
authors.lastname: Hilbrands
authors.affiliation: Department of Nephrology, Medical University of Vienna, Vienna, Austria.
authors.forename: Rainer
authors.initials: R
authors.lastname: Oberbauer
authors.affiliation: Transplant Unit, Royal Infirmary of Edinburgh, Little France Crescent, Edinburgh, UK.
authors.forename: Gabriel C
authors.initials: GC
authors.lastname: Oniscu
authors.affiliation: Department of Nephrology, Hospital del Mar Barcelona, Barcelona, Spain.
authors.forename: Julio
authors.initials: J
authors.lastname: Pascual
authors.affiliation: Department of Nephrology, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark.
authors.forename: Soren
authors.initials: S
authors.lastname: Schwartz Sorensen
authors.affiliation: Department of Nephrology, Institute for Clinical and Experimental Medicine, Prague, Czech Republic.
authors.forename: Ondrej
authors.initials: O
authors.lastname: Viklicky
authors.affiliation: Department of Nephrology, Antwerp University Hospital, Antwerp, Belgium.
authors.forename: Daniel
authors.initials: D
authors.lastname: Abramowicz
mesh_terms: D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology*; D016030:Kidney Transplantation; D019520:Living Donors; D009392:Nephrectomy / Q000009:adverse effects*; D012307:Risk Factors; D020858:Tissue and Organ Harvesting / Q000009:adverse effects*