Comorbidity Burden and Perioperative Complications for Living Kidney Donors in the United States.

, †Cleveland Clinic Lerner College of Medicine, Case Western Reserve University, Cleveland, Ohio, ‖The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, Massachusetts.
Clinical Journal of the American Society of Nephrology (Impact Factor: 5.25). 09/2013; DOI: 10.2215/CJN.12311212
Source: PubMed

ABSTRACT Since 1998, 35% of kidney transplants in the United States have been derived from living donors. Research suggests minimal long-term health consequences after donation, but comprehensive studies are limited. The primary objective was to evaluate trends in comorbidity burden and complications among living donors.
The National Inpatient Sample (NIS) was used to identify donors from 1998 to 2010 (n=69,117). Comorbid conditions, complications, and length of stay during hospitalization were evaluated. Outcomes among cohorts undergoing appendectomies, cholecystectomies and nephrectomy for nonmetastatic carcinoma were compared, and sample characteristics were validated with the Scientific Registry of Transplant Recipients (SRTR). Survey regression models were used to identify risk factors for outcomes.
The NIS captured 89% (69,117 of 77,702) of living donors in the United States. Donor characteristics were relatively concordant with those noted in SRTR (mean age, 40.1 versus 40.3 years [P=0.18]; female donors, 59.0% versus 59.1% [P=0.13]; white donors, 68.4% versus 69.8% [P<0.001] for NIS versus SRTR). Incidence of perioperative complications was 7.9% and decreased from 1998 to 2010 (from 10.1% to 7.6%). Men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 1.20 to 1.56) and donors with hypertension (AOR, 3.35; 95% CI, 2.24 to 5.01) were more likely to have perioperative complications. Median length of stay declined over time (from 3.7 days to 2.5 days), with longer length of stay associated with obesity, depression, hypertension, and pulmonary disorders. Presence of depression (AOR, 1.08; 95% CI, 1.04 to 1.12), hypothyroidism (AOR, 1.07; 95% CI, 1.04 to 1.11), hypertension (AOR, 1.38; 95% CI, 1.27 to 1.49), and obesity (AOR, 1.07; 95% CI, 1.03 to 1.11) increased over time. Complication rates and length of stay were similar for patients undergoing appendectomies and cholecystectomies but were less than those with nephrectomies for carcinoma.
The NIS is a representative sample of living donors. Complications and length of stay after donation have declined over time, while presence of documented comorbid conditions has increased. Patients undergoing appendectomy and cholecystectomy have similar outcomes during hospitalization. Monitoring the health of living donors remains critically important.

  • Source
    [Show abstract] [Hide abstract]
    ABSTRACT: The 3rd International Transplant Conference took place on 31st October and 1st November 2014 at the University of Warwick, Coventry, UK. Key focal points of the meeting were the exploration of the molecular basis of antibody-antigen interactions and their relation to clinical practice and to share experiences and knowledge regarding strategies to transplant the 'high-risk' patient. In addition, lively debate sessions were hosted where controversial clinical and immunological themes were discussed by leading experts in the field. © 2015 John Wiley & Sons Ltd.
    International Journal of Immunogenetics 02/2015; DOI:10.1111/iji.12184 · 1.34 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Purpose of review The current era of organ shortage has necessitated a widening of criteria for donation, considering donors who would have been considered unsuitable before. This review summarizes the recent advances in strategies to maximize the use of marginal kidneys without compromising the outcomes. Recent findings Various strategies have been studied and implemented to optimize procurement and allocation of marginal kidneys, and to preserve their function. In particular, a growing number of transplant centers are using donors after circulatory death. Whereas normothermic ex-vivo and postmortem perfusion are promising procedures to improve the outcomes of marginal grafts in the future, dual-kidney transplantation is a viable approach which is at present potentially underutilized. Despite active research on new strategies to evaluate organ quality, pretransplant biopsy assessment currently remains the most reliable method. The practice of using living donors with advanced age is supported by available evidence, whereas the use of young living donors with minor medical abnormalities needs further investigation. Summary Progress has been made in the recent years, clarifying the best criteria for evaluating, recovering, and allocating marginal kidney donors. However, further research is needed, with special regards to the criteria for using marginal living-kidney donors.
    Current Opinion in Organ Transplantation 06/2014; 19(4). DOI:10.1097/MOT.0000000000000081 · 2.38 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Aim of this study is to provide a systematic review and meta-analysis of studies comparing laparoendoscopic single site (LESS) versus standard laparoscopic living donor nephrectomy (LDN). A systematic review of the literature was performed in September 2013 using PubMed, Scopus, Ovid and The Cochrane library databases. Article selection proceeded according to the search strategy based on Preferred Reporting Items for Systematic Reviews and Meta-analyses criteria. Weighted mean difference was used to measure continuous variables and odds ratio to measure categorical ones. Nine publications meeting eligibility criteria were identified, including 461 LESS and 1006 laparoscopic LDN cases. There was a higher number of left side cases in the LESS group (96.5% vs 88.6%, p<0.001). Meta-analysis of extractable data showed that laparoscopy was associated with a shorter operative time (15.06 min; 4.9-25.1; p=0.003), without significant difference in terms of warm ischemia time (0.41 min, -0.02, 0.84; p = 0.06). EBL was lower for LESS (-22.09 ml; -29.5, -14.6; p<0.0001), this difference being however not clinically significant. A higher likelihood of conversion was detected for LESS (13.21; 4.65, 37.53; p<0.0001). Hospital stay was similar (-0.11 days; -0.33, 0.12; p=0.35) as well as visual analog pain score at discharge (-0.31; -0.96, 0.35; p=0.36), but the analgesic requirement was lower for LESS (-2.58; -5.01, -0.15; p=0.04). Moreover, no difference was found in terms of postoperative complication rate (1.00; 0.65, 1.54; p=0.99). Renal function of the recipient as based on creatinine levels at 1 month showed similar outcomes between groups (0.10 mg/dl; -0.09, 0.29; p=0.29). LESS LDN represents an emerging option for living kidney donation. This procedure offers comparable surgical and early functional outcomes to the conventional laparoscopic procedure, and a lower analgesic requirement. However, it is more technically challenging than its standard laparoscopic counterpart, as demonstrated by a higher likelihood of conversion. The role of LESS LDN remains to be defined.
    BJU International 03/2014; DOI:10.1111/bju.12724 · 3.13 Impact Factor