The lack of deceased donors in Japan means that living-donor kidney transplantation is necessary in as many as 80% of cases. However, there are few data on perioperative complications and long-term outcome for live kidney donors.
To determine associated perioperative morbidity and long-term mortality among live kidney donors, we reviewed 601 donor nephrectomies performed at our institution between 1970 and 2006 and attempted to contact all of the donors (or their families) to ascertain their present physical status. The survival rate and causes of death were compared with an age- and gender-matched cohort from the general population.
Although three donors (0.5%) experienced major perioperative complications, that is, femoral nerve compression, pulmonary thrombosis, and acute renal failure, all of the donors recovered and left hospital without complications. Among 481 donors (80%) for whom details were available at the time of inspection, 426 (88.5%) were still surviving. Donor survival rates at 5, 10, 20, and 30 years were 98.3%, 94.7%, 86.4%, and 66.2%, respectively. The mean interval between kidney donation and death was 183+/-102 (7-375) months, and the mean age at death was 70+/-11 years. The survival rate of kidney donors was better than the age- and gender-matched cohort from the general population, and the patterns and causes of death were similar.
Our data suggest that continuation of living-donor kidney transplantation programs is justified in short- and long-term donor safety.
"Beyond the first 5 years after donation, blood pressure in the donors was 5 mmHg higher in kidney donors than controls . Okamoto et al.  reported that 31.1% of Japanese donors were hypertensive after 7–406 months of follow-up, a proportion similar to that reported by Fehrman-Ekholm . Ibrahim et al.  "
[Show abstract][Hide abstract] ABSTRACT: Living kidney donors face a unique decision of self-sacrifice that is not without potential risk. The purpose of this review is to highlight existing research regarding the perioperative morbidity, mortality and long-term outcomes of living kidney donors.
Recent studies of long-term donor survival have affirmed that the life expectancy for living kidney donors is excellent and their risk of end-stage renal disease (ESRD) is not increased. Long-term health outcomes for living donors representing minority groups, however, may not be as favorable. Recent studies conclude that African-American and Hispanic donors, similarly to nondonors of the same race, are at higher risk of developing chronic kidney disease (CKD), hypertension, and diabetes mellitus. Outcomes in medically complex donors have also generated considerable attention, and the evidence on outcomes among otherwise healthy obese and older donors appears to be reassuring.
Living kidney donation is a superior transplantation option for many individuals with ESRD. The survival and health consequences of living donation have proven to be excellent. These favorable outcomes stem from careful screening measures, and further research endeavors are needed to ensure long-term living donor safety in high-risk donors.
Current opinion in nephrology and hypertension 09/2011; 20(6):605-9. DOI:10.1097/MNH.0b013e32834bd72b · 3.96 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: A computer wireless-controlled mobile vehicle is described. The vehicle is designed to optimize the cinematic and dynamic behaviours. It has a circular shape, two fixed axis driven wheels, independent brushless motors coupled with a pair of ball wheels; and a third actuator driving a spinning turret (superior platform) to reduce the inertial couple during the turns. The feedback signals are generated by two optical incremental encoders linked to the motor shafts for velocity signals and by odometric sensors for position signals. Two track-balls, each of them with two encoders, are used to measure and control the mobile robot displacement on the floor. Moreover, a protection bumper surrounds the perimeter of the lower platform and it works like a switch. Several experimental tests have been developed and we show the evaluation of the position error in a closed loop paths, reporting the difference between the starting point and the final one. The motion control strategy is described with comments about the choice of the control parameters.
[Show abstract][Hide abstract] ABSTRACT: The clinical course and risk factors for developing end-stage renal disease (ESRD) after heminephrectomy in living kidney donors have scarcely been investigated. We reviewed medical records and identified eight case donors who developed chronic kidney disease (CKD) stage 5 or ESRD, and subsequently investigated the association between postoperative clinical courses and changes in renal function. To conduct a case-control study, we also selected a control group comprising 24 donors who had maintained stable renal function and were matched for age, sex and follow-up time since donation. Except for one donor who developed ESRD caused by a traffic accident, none of the donors developed progressive renal dysfunction immediately after donation. Their renal functions remained stable for a long period of time, but started to decline after developing new comorbidities, especially risk factors known as progression factors (proteinuria or hypertension) or accelerating factors (cardiovascular [CV] event or infection) of CKD. As compared with the control donors, incidence of postoperative persistent proteinuria, acute CV event, severe infection and hospitalization due to accelerating factors of CKD were significantly higher in the case donors. These results suggest the importance of long-term (more than 10 years) follow-up of donors with special attention on the risk factors of CKD.
American Journal of Transplantation 09/2009; 9(11):2514-9. DOI:10.1111/j.1600-6143.2009.02795.x · 5.68 Impact Factor
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