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Kakuta Y, Maegawa-Higa Y, Matsumura S, Fukae S, Tanaka R, Yonishi H, Nakazawa S, Yamanaka K, Isaka Y, Nonomura N. Performance of the New CKD-EPI Creatinine-and Cystatin C-based Glomerular Filtration Rate Estimation Equation in Living Kidney Donor Candidate. Transplant Direct 2024; 10:e1712. [PMID: 39310284 PMCID: PMC11415128 DOI: 10.1097/txd.0000000000001712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2024] [Revised: 07/29/2024] [Accepted: 07/31/2024] [Indexed: 09/25/2024] Open
Abstract
Background Accurate preoperative evaluation of renal function in living kidney donor candidates (LKDCs) is crucial to prevent kidney failure after nephrectomy. We examined the performance of various estimated glomerular filtration rate (eGFR) equations, including the new chronic kidney disease epidemiology collaboration (CKD-EPI) equation in LKDCs. Methods We analyzed 752 LKDCs who were assessed for measured GFR by inulin clearance as part of routine pretransplant examination from 2006 to 2020. CKD-EPI2012 from cystatin C (CKD-EPI12cys), CKD-EPI2021 from creatinine (CKD-EPI21cr), CKD-EPI21cr-cys, Japanese modified (JPN) eGFRcr, and JPN eGFRcys were compared in determining the suitability for LKDCs. Results CKD-EPI12cys had the lowest absolute and relative biases, with higher P30 and P10, followed by JPN eGFRcys, CKD-EPI21cr, and CKD-EPI21cr-cys. The root mean square error was least for CKD-EPI12cys, then JPN eGFRcys, CKD-EPI21cr-cys, CKD-EPI21cr, and JPN eGFRcr. CKD-EPI21cr, CKD-EPI12cys, and CKD-EPI21cr-cys estimated GFR higher, whereas JPN eGFRcr estimated GFR lower. At the threshold of 90 mL/min/1.73 m2, CKD-EPI21cr had the highest percentage of misclassification at 37.37%, whereas JPN eGFRcr had the lowest percentage of misclassification at 6.91%. Using the age-adapted approach, JPN eGFRcr had the lowest percentage of misclassification into overestimation at 7.31%. All eGFR had >5.0%, and CKD-EPI21cr had the highest percentage of misclassification at 21.94%. Conversely, CKD-EPI21cr-cys had the lowest percentage of misclassification into underestimation at 3.19%, both at the threshold of 90 mL/min/1.73 m2 and the age-adapted approach. JPN eGFRcr had the highest percentage at 33.38% and 40.69%, respectively. Conclusions In evaluating the renal function of Japanese LKDCs, the new CKD-EPI equation had a lower rate of underestimation but a relatively high rate of overestimation. New GFR estimation formulas are needed to be tailored to each ethnic group to enhance the accuracy and reliability of donor selection processes.
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Affiliation(s)
- Yoichi Kakuta
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Yoko Maegawa-Higa
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Soichi Matsumura
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Shota Fukae
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Ryo Tanaka
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Hiroaki Yonishi
- Department of Nephrology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Shigeaki Nakazawa
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Kazuaki Yamanaka
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Yoshitaka Isaka
- Department of Nephrology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
| | - Norio Nonomura
- Department of Urology, Osaka Graduate School of Medicine, Suita city, Osaka, Japan
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Evans MD, Helgeson ES, Rule AD, Vock DM, Matas AJ. Consequences of low estimated glomerular filtration rate either before or early after kidney donation. Am J Transplant 2024; 24:1816-1827. [PMID: 38878866 PMCID: PMC11439579 DOI: 10.1016/j.ajt.2024.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Revised: 03/20/2024] [Accepted: 04/20/2024] [Indexed: 07/11/2024]
Abstract
In the general population, decreases in glomerular filtration rate (GFR) are associated with subsequent development of chronic kidney disease (CKD), cardiovascular disease (CVD), and death. It is unknown if low estimated GFR (eGFR) before or early after kidney donation was also associated with these risks. One thousand six hundred ninety-nine living donors who had both predonation and early (4-10 weeks) postdonation eGFR were included. We studied the relationships between eGFR, age at donation, and the time to sustained eGFR<45 (CKD stage 3b) and <30 mL/min/1.73m2 (CKD stage 4), hypertension, diabetes mellitus (DM), CVD, and death. Median follow-up was 12 (interquartile range, 6-21) years. Twenty-year event rates were 5.8% eGFR<45 mL/min/1.73m2; 1.2% eGFR<30 mL/min/1.73m2; 29.0% hypertension; 7.8% DM; 8.0% CVD; and 5.2% death. The median time to eGFR<45 mL/min/1.73m2 (N = 79) was 17 years, and eGFR<30 mL/min/1.73m2 (N = 22) was 25 years. Both low predonation and early postdonation eGFR were associated with eGFR<45 mL/min/1.73m2 (P < .0001) and eGFR<30 mL/min/1.73m2 (P < .006); however, the primary driver of risk for all ages was low postdonation (rather than predonation) eGFR. Predonation and postdonation eGFR were not associated with hypertension, DM, CVD, or death. Low predonation and early postdonation eGFR are risk factors for developing eGFR<45 mL/min/1.73m2 (CKD stage 3b) and <30 mL/min/1.73m2 (CKD stage 4), but not CVD, hypertension, DM, or death.
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Affiliation(s)
- Michael D Evans
- Clinical and Translational Science Institute, University of Minnesota, Minneapolis, Minnesota, USA
| | - Erika S Helgeson
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - David M Vock
- Division of Biostatistics and Health Data Science, School of Public Health, University of Minnesota, Minneapolis, Minnesota, USA
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
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Mainzer RM, Moreno-Betancur M, Nguyen CD, Simpson JA, Carlin JB, Lee KJ. Gaps in the usage and reporting of multiple imputation for incomplete data: findings from a scoping review of observational studies addressing causal questions. BMC Med Res Methodol 2024; 24:193. [PMID: 39232661 PMCID: PMC11373423 DOI: 10.1186/s12874-024-02302-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2024] [Accepted: 08/02/2024] [Indexed: 09/06/2024] Open
Abstract
BACKGROUND Missing data are common in observational studies and often occur in several of the variables required when estimating a causal effect, i.e. the exposure, outcome and/or variables used to control for confounding. Analyses involving multiple incomplete variables are not as straightforward as analyses with a single incomplete variable. For example, in the context of multivariable missingness, the standard missing data assumptions ("missing completely at random", "missing at random" [MAR], "missing not at random") are difficult to interpret and assess. It is not clear how the complexities that arise due to multivariable missingness are being addressed in practice. The aim of this study was to review how missing data are managed and reported in observational studies that use multiple imputation (MI) for causal effect estimation, with a particular focus on missing data summaries, missing data assumptions, primary and sensitivity analyses, and MI implementation. METHODS We searched five top general epidemiology journals for observational studies that aimed to answer a causal research question and used MI, published between January 2019 and December 2021. Article screening and data extraction were performed systematically. RESULTS Of the 130 studies included in this review, 108 (83%) derived an analysis sample by excluding individuals with missing data in specific variables (e.g., outcome) and 114 (88%) had multivariable missingness within the analysis sample. Forty-four (34%) studies provided a statement about missing data assumptions, 35 of which stated the MAR assumption, but only 11/44 (25%) studies provided a justification for these assumptions. The number of imputations, MI method and MI software were generally well-reported (71%, 75% and 88% of studies, respectively), while aspects of the imputation model specification were not clear for more than half of the studies. A secondary analysis that used a different approach to handle the missing data was conducted in 69/130 (53%) studies. Of these 69 studies, 68 (99%) lacked a clear justification for the secondary analysis. CONCLUSION Effort is needed to clarify the rationale for and improve the reporting of MI for estimation of causal effects from observational data. We encourage greater transparency in making and reporting analytical decisions related to missing data.
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Affiliation(s)
- Rheanna M Mainzer
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia.
| | - Margarita Moreno-Betancur
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Cattram D Nguyen
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Julie A Simpson
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3052, Australia
- Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - John B Carlin
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, 3052, Australia
| | - Katherine J Lee
- Clinical Epidemiology and Biostatistics Unit, Murdoch Children's Research Institute, Parkville, Victoria, 3052, Australia
- Department of Paediatrics, The University of Melbourne, Parkville, Victoria, 3052, Australia
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Hori S, Tomizawa M, Inoue K, Yoneda T, Nakahama T, Onishi K, Morizawa Y, Gotoh D, Nakai Y, Miyake M, Torimoto K, Tanaka N, Fujimoto K. Follow-up After Donor Nephrectomy in Living Kidney Donors: How to Manage Living Kidney Donors Postoperatively. In Vivo 2024; 38:1900-1910. [PMID: 38936934 PMCID: PMC11215566 DOI: 10.21873/invivo.13645] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2024] [Revised: 04/09/2024] [Accepted: 04/10/2024] [Indexed: 06/29/2024]
Abstract
BACKGROUND/AIM This study investigated the follow-up rate of living kidney donors and explored the factors related to continuous follow-up and remnant renal function, enabling the optimal management of living kidney donors. PATIENTS AND METHODS We retrospectively evaluated 180 living kidney donors who underwent donor nephrectomies at our institute. Clinical information was obtained from medical charts, and remnant renal function was defined as the estimated glomerular filtration rate 12 months after donor nephrectomy. RESULTS Overall, 6/180 donors (3.3%) were lost to follow-up within a year, and the follow-up rate gradually declined yearly. Independent risk factors for loss to follow-up included a follow-up period <60 months and graft survival of the recipient (p=0.002 and p=0.043, respectively). Recipient survival was correlated with loss to follow-up; however, this was not significant (p=0.051). Regarding remnant renal function, age ≥60 years, preoperative estimated glomerular filtration rate <74 ml/min/1.73 m2, and a Δsingle-kidney estimated glomerular filtration rate <9.3 ml/min/1.73m2 were independent risk factors for poorly preserved remnant renal function (p=0.036, p<0.0001, and p<0.0001, respectively). Using propensity score matching to adjust for preoperative factors, a Δsingle-kidney estimated glomerular filtration rate <9.3 ml/min/1.73 m2 was the only significant postoperative factor for poorly preserved remnant renal function (p=0.023). CONCLUSION An increased 5-year follow-up rate could lead to an increase in long-term follow-up, and recipient prognosis may be correlated with the living kidney donor follow-up status. Furthermore, Δsingle-kidney estimated glomerular filtration rate was identified as a factor for establishing the optimal precision follow-up management of living kidney donors.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Kuniaki Inoue
- Department of Urology, Nara Medical University, Nara, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Kenta Onishi
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Daisuke Gotoh
- Department of Urology, Nara Medical University, Nara, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, Nara, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, Nara, Japan
| | | | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, Nara, Japan
- Department of Prostate Brachytherapy, Nara Medical University, Nara, Japan
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5
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Hirose T, Hotta K, Osawa T, Yokota I, Inao T, Tanabe T, Iwahara N, Shinohara N. Longitudinal mortality risks and kidney functional outcomes in Japanese living kidney donors. Int J Urol 2024; 31:519-524. [PMID: 38240161 DOI: 10.1111/iju.15395] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Accepted: 01/04/2024] [Indexed: 05/05/2024]
Abstract
OBJECTIVES Previous studies suggested that living kidney donors do not have a higher risk of death or kidney failure than the general population. However, living kidney donor risk is controversial. Furthermore, only a few studies have evaluated long-term kidney function after kidney donation. METHODS This study evaluated Japanese kidney donor' long-term outcomes, including mortality and kidney function. From 1965 to 2015, 230 donors (76 males, 154 females, and a median age of 54) were enrolled in this study. The median observation period was 11.0 (range, 0.3-41.0) years. RESULTS In total, 215 donors were still alive, and 15 had died. Causes of death included malignancies, cardiovascular disease, pneumonia, suicide, gastrointestinal bleeding, and kidney failure. Actual donor survival rates at 10, 20, and 30 years were 95.3%, 90.7%, and 80.9%, respectively. These values were comparable to age- and gender-matched expected survival. Long-term kidney function after donation was evaluated in 211 donors with serum creatinine data. Two donors developed kidney failure 24 and 26 years post-donation, respectively. The percentage of donors whose estimated glomerular filtration rate (eGFR) remained ≥45 mL/min/1.73 m2 at 10, 20, and 30 years after donation were 84.2%, 73.0%, and 63.9%, respectively. Survival rates of donors with eGFR <45 mL/min/1.73 m2 were comparable to those in persons with eGFR >45 mL/min/1.73 m2. CONCLUSION Our findings revealed that kidney donors did not have a higher long-term risk of death than the general population. Although some donors showed decreased kidney function after donation, kidney function did not impact their survival.
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Affiliation(s)
- Takayuki Hirose
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Kiyohiko Hotta
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Takahiro Osawa
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Isao Yokota
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tasuku Inao
- Department of Biostatistics, Graduate School of Medicine, Hokkaido University, Sapporo, Hokkaido, Japan
| | - Tatsu Tanabe
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Naoya Iwahara
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
| | - Nobuo Shinohara
- Department of Urology, Hokkaido University Hospital, Sapporo, Hokkaido, Japan
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6
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Rabbani MU, Reed RD, McLeod MC, MacLennan PA, Kumar V, Locke JE. Health Inequity in Likelihood and Time to Renal Recovery after Living Kidney Donation: Implications for Kidney Health in Black Americans. J Am Coll Surg 2024; 238:647-653. [PMID: 38224079 PMCID: PMC10947888 DOI: 10.1097/xcs.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024]
Abstract
BACKGROUND Live donor kidney transplantation has been popularized to help mitigate the organ shortage crisis. At the time of living donor nephrectomy, living donors lose 50% of their kidney function or glomerular filtration rate (GFR). Studies have shown that in healthy living donors, the remaining kidney is able to adapt and recover 10% to 25% of postdonation lost GFR. GFR recovery is critical to long-term kidney health, particularly for Black Americans who disproportionately suffer from kidney disease with an incidence 2.5 times White Americans. To date, no study has examined whether health inequities in renal recovery postdonation exist. STUDY DESIGN We retrospectively analyzed 100,121 living kidney donors reported to the Scientific Registry of Transplant Recipients between 1999 and 2021. We estimated GFR (eGFR) using the Chronic Kidney Disease Epidemiology Collaboration 2021 equation and predicted the likelihood (logistic regression) and time (Cox regression) to recovery of 60% and 75% predonation eGFR. Models adjusted for age, sex, race, BMI, and predonation eGFR. RESULTS Black patients were 47% (adjusted odds ratio 0.53, 95% CI 0.50 to 0.56, p < 0.001) and 43% (adjusted odds ratio 0.57, 95% CI 0.54 to 0.60, p < 0.001) less likely to recover 60% and 75% of predonation eGFR, respectively, compared with their White counterparts. The hazard ratio for time to renal recovery of 60% and 75% of predonation eGFR was 22% (adjusted hazard ratio 0.78, 95% CI 0.76 to 0.80, p < 0.001) and 38% (adjusted hazard ratio 0.62, 95% CI 0.60 to 0.65, p < 0.001) lower, respectively, than White patients. CONCLUSIONS Black living kidney donors were less likely to recover predonation eGFR, and time to renal recovery was significantly longer than their White counterparts. These data highlight the need for enhanced living kidney donor follow-up, particularly for Black living kidney donors who are at greatest future risk of end-stage kidney disease.
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Affiliation(s)
- Muhammad Umaid Rabbani
- From the Comprehensive Transplant Institute, University of Alabama at Birmingham, Birmingham, AL
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7
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Keleş A, Kaya C. A comparison of pre- and post-operative outcomes in living donors undergoing transperitoneal laparoscopic nephrectomy and open nephrectomy: a retrospective single-center study. SAO PAULO MED J 2023; 142:e2022488. [PMID: 38088685 PMCID: PMC10708893 DOI: 10.1590/1516-3180.2022.0488.r1.070723] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Revised: 05/05/2023] [Accepted: 07/07/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Kidney transplantation is often regarded as the preferred therapy for end-stage renal disease. Several surgical procedures have been developed to reduce postoperative donor complications, while maintaining kidney quality. OBJECTIVE This study aimed to compare the preoperative and postoperative outcomes of living kidney donors who underwent either transperitoneal laparoscopic nephrectomy or open nephrectomy. DESIGN AND SETTING Retrospective study conducted in Istanbul, Turkey. METHODS Fifty-five living-related kidney donors underwent nephrectomy and were retrospectively divided into two groups: 21 donors who underwent open nephrectomy (Group 1) and 34 donors who underwent transperitoneal laparoscopic nephrectomy (Group 2). RESULTS In comparison to the donors who underwent open nephrectomy, those who underwent transperitoneal laparoscopic nephrectomy had significantly shorter postoperative hospital stays (2.3 ± 0.2 versus 3.8 ± 0.8 days, P = 0.003), duration of urinary catheterization (1.2 ± 0.8 days versus 2.0 ± 0.7 days, P = 0.0001), operating times (210 ± 27 minutes versus 185 ± 24 minutes, P = 0.02), and less blood loss (86 ml versus 142 ml, P = 0.048). There was no statistically significant difference between the two groups with regard to the estimated blood transfusion and warm ischemia time. The preoperative week, first postoperative week, and 1-month postoperative serum creatinine levels were comparable between the groups. CONCLUSIONS Laparoscopic donor nephrectomy can be safely performed at centers with expertise in laparoscopic surgery. Laparoscopic donor nephrectomy has better outcomes than open donor nephrectomy in terms of length of hospital stay, duration of urinary catheterization, operating time, and blood loss.
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Affiliation(s)
- Ahmet Keleş
- MD. Urologist, Department of Urology, School of Medicine,
Istanbul Medeniyet University, Uskudar, Turkey
| | - Cevdet Kaya
- MD. Professor of Urology, Department of Urology, School of
Medicine, Marmara University, Istanbul, Turkey
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8
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Xagas E, Sarafidis P, Iatridi F, Theodorakopoulou MP, Pella E, Korogiannou M, Argyris A, Protogerou A, Boletis IN, Marinaki S. Kidney transplantation and kidney donation do not affect short-term blood pressure variability. Blood Press 2023; 32:2181640. [PMID: 36814377 DOI: 10.1080/08037051.2023.2181640] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
PURPOSE Blood pressure variability (BPV) is an independent cardiovascular risk factor in CKD. Kidney transplantation (KTx) is associated with improved BP levels for kidney transplant recipient (KTRs), without evoking significant changes in donors. The aim of this study was to assess the short- and mid-time effects of KTx and donation on short-term BPV in KTRs and their respective living kidney donors. MATERIALS AND METHODS Forty KTRs and their respective donors were evaluated with 24-h ABPM (Mobil-O-Graph-NG) at baseline (1 month before), 3-months and 12-months after KTx. Standard-deviation (SD), weighted-SD (wSD), coefficient-of-variation (CV), average-real-variability (ARV) and variability independent of mean (VIM) for SBP/DBP were calculated with validated formulas. RESULTS All 24-h systolic and diastolic BPV indexes studied did not change significantly from baseline to 3-month (SBP-wSD: 12.8 ± 3.0 vs 13.2 ± 3.4 mmHg, p = 0.608; SBP-ARV: 10.3 ± 2.4 vs 10.8 ± 2.6 mmHg, p = 0.463) and 12-month evaluation (SBP-wSD 12.8 ± 3.0 vs 12.1 ± 2.8; p = 0.424 and SBP-ARV: 10.3 ± 2.4 vs 10.2 ± 2.5; p = 0.615) after kidney transplantation in the KTRs.In kidney donors, all 24-h systolic BPV indices displayed a trend towards higher values at 3 months compared to baseline, but without reaching statistical significance (SBP-wSD: 12.2 ± 2.8 vs 13.6 ± 4.2 mmHg, p = 0.107 and SBP-ARV: 10.1 ± 2.1 vs 11.2 ± 3.1 mmHg, p = 0.099), the levels of 24-h systolic SBP indices at 12-months were almost identical to baseline values. 24-h diastolic BPV indices at 3-month and 12-month evaluation were similar to baseline. CONCLUSION Short-term BPV did not change significantly 3 and 12 months after kidney transplantation/donation neither in KTRs nor in living kidney donors. Longitudinal studies examining associations of BPV with adverse outcomes in these individuals are needed.
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Affiliation(s)
- Efstathios Xagas
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Pantelis Sarafidis
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Fotini Iatridi
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Marieta P Theodorakopoulou
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Eva Pella
- Department of Nephrology, Hippokration Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Maria Korogiannou
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Antonis Argyris
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Athanase Protogerou
- Cardiovascular Prevention & Research Unit, Clinic & Laboratory of Pathophysiology, Laiko General Hospital, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - Ioannis N Boletis
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
| | - Smaragdi Marinaki
- Clinic of Nephrology and Renal Transplantation, Laiko General Hospital, Medical School of Athens, National and Kapodistrian University of Athens, Athens, Greece
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van Buren MC, Meinderts JR, Oudmaijer CAJ, de Jong MFC, Groen H, Royaards T, Maasdam L, Tielen M, Reinders MEJ, Lely AT, van de Wetering J. Long-Term Kidney and Maternal Outcomes After Pregnancy in Living Kidney Donors. Transpl Int 2023; 36:11181. [PMID: 37448449 PMCID: PMC10337757 DOI: 10.3389/ti.2023.11181] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 06/12/2023] [Indexed: 07/15/2023]
Abstract
For counseling it is important to know if pregnancy after Living Kidney Donation (LKD) affects long-term outcomes of the mono-kidney and the mother. Therefore, we performed a retrospective multicenter study in women ≤45 years who donated their kidney between 1981 and 2017. Data was collected via questionnaires and medical records. eGFR of women with post-LKD pregnancies were compared to women with pre-LKD pregnancies or nulliparous. eGFR before and after pregnancy were compared in women with post-LKD pregnancies. Pregnancy outcomes post-LKD were compared with pre-LKD pregnancy outcomes. 234 women (499 pregnancies) were included, of which 20 with pre- and post-LKD pregnancies (68) and 26 with only post-LKD pregnancies (59). Multilevel analysis demonstrated that eGFR was not different between women with and without post-LKD pregnancies (p = 0.23). Furthermore, eGFR was not different before and after post-LKD pregnancy (p = 0.13). More hypertensive disorders of pregnancy (HDP) occurred in post-LKD pregnancies (p = 0.002). Adverse fetal outcomes did not differ. We conclude that, despite a higher incidence of HDP, eGFR was not affected by post-LKD pregnancy. In line with previous studies, we found an increased risk for HDP after LKD without affecting fetal outcome. Therefore, a pregnancy wish alone should not be a reason to exclude women for LKD.
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Affiliation(s)
- Marleen C. van Buren
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Jildau R. Meinderts
- Department of Nephrology, University Medical Center Groningen, Groningen, Netherlands
| | - Christiaan A. J. Oudmaijer
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | | | - Henk Groen
- Department of Epidemiology, University of Groningen, Groningen, Netherlands
| | - Tessa Royaards
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Louise Maasdam
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Mirjam Tielen
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - Marlies E. J. Reinders
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
| | - A. Titia Lely
- Department of Obstetrics, Wilhelmina Children’s Hospital Birth Center, University Medical Center Utrecht, Utrecht, Netherlands
| | - Jacqueline van de Wetering
- Department of Internal Medicine, Erasmus MC Transplant Institute, University Medical Center, Rotterdam, Netherlands
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10
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Matas AJ, Rule AD. Long-term Medical Outcomes of Living Kidney Donors. Mayo Clin Proc 2022; 97:2107-2122. [PMID: 36216599 PMCID: PMC9747133 DOI: 10.1016/j.mayocp.2022.06.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 06/03/2022] [Accepted: 06/13/2022] [Indexed: 12/15/2022]
Abstract
Historically, to minimize risks, living kidney donors have been highly selected and healthy. Operative risks are well-defined, yet concern remains about long-term risks. In the general population, even a mild reduction in glomerular filtration rate (GFR) is associated with cardiovascular disease, chronic kidney disease, and end-stage kidney disease (ESKD). However, reduction in GFR in the general population is due to kidney or systemic disease. Retrospective studies comparing donors with matched general population controls have found no increased donor risk. Prospective studies comparing donors with controls (maximum follow-up, 9 years) have reported that donor GFR is stable or increases slightly, whereas GFR decreases in controls. However, these same studies identified metabolic and vascular donor abnormalities. There are a few retrospective studies comparing donors with controls. Each has limitations in selection of the control group, statistical analyses, and/or length of follow-up. One such study reported increased donor mortality; 2 reported a small increase in absolute risk of ESKD. Risk factors for donor ESKD are similar to those in the general population. Postdonation pregnancies are also associated with increased risk of hypertension and preeclampsia. There is a critical need for long-term follow-up studies comparing donors with controls from the same era, geographic area, and socioeconomic status who are healthy, with normal renal function on the date matching the date of donation, and are matched on demographic characteristics with the donors. These data are needed to optimize donor candidate counseling and informed consent.
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Affiliation(s)
- Arthur J Matas
- Transplantation Division, Department of Surgery, University of Minnesota, Minneapolis.
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
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11
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Laham G, Ponti JP, Soler Pujol G. Assessing Renal Function for Kidney Donation. How Low Is Too Low? Front Med (Lausanne) 2022; 8:784435. [PMID: 35186970 PMCID: PMC8847393 DOI: 10.3389/fmed.2021.784435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 12/09/2021] [Indexed: 11/13/2022] Open
Abstract
Kidney transplantation (KT) is the treatment of choice for patients with end-stage kidney disease (ESKD) with decreased morbi-mortality, improved life quality, and reduced cost. However, the shortage of organs from deceased donors led to an increase in KT from living donors. Some stipulate that living donors have a higher risk of ESKD after donation compared with healthy non-donors. The reason for this is not clear. It is possible that ESKD is due to the nephrectomy-related reduction in glomerular filtration rate (GFR), followed by an age-related decline that may be more rapid in related donors. It is essential to assess donors properly to avoid rejecting suitable ones and not accepting those with a higher risk of ESKD. GFR is a central aspect of the evaluation of potential donors since there is an association between low GFR and ESKD. The methods for assessing GFR are in continuous debate, and the kidney function thresholds for accepting a donor may vary according to the guidelines. While direct measurements of GFR (mGFR) provide the most accurate evaluation of kidney function, guidelines do not systematically use this measurement as a reference. Also, some studies have shown that the GFR decreases with age and may vary with gender and race, therefore, the lower limit of GFR in patients eligible to donate may vary based on these demographic factors. Finally, it is known that CrCl overestimates mGFR while eGFR underestimates it, therefore, another way to have a reliable GFR could be the combination of two measurement methods.
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Affiliation(s)
- Gustavo Laham
- Internal Medicine Department, Nephrology Section, Centro de Educación Médica e Investigaciones Clínicas Norberto Quirno (CEMIC), Buenos Aires, Argentina
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12
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Ferro CJ, Townend JN. Risk for subsequent hypertension and cardiovascular disease after living kidney donation: is it clinically relevant? Clin Kidney J 2021; 15:644-656. [PMID: 35371443 PMCID: PMC8967677 DOI: 10.1093/ckj/sfab271] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Indexed: 11/17/2022] Open
Abstract
The first successful live donor kidney transplant was performed in 1954. Receiving a kidney transplant from a live kidney donor remains the best option for increasing both life expectancy and quality of life in patients with end-stage kidney disease. However, ever since 1954, there have been multiple questions raised on the ethics of live kidney donation in terms of negative impacts on donor life expectancy. Given the close relationship between reduced kidney function in patients with chronic kidney disease (CKD) and hypertension, cardiovascular disease and cardiovascular mortality, information on the impact of kidney donation on these is particularly relevant. In this article, we review the existing evidence, focusing on the more recent studies on the impact of kidney donation on all-cause mortality, cardiovascular mortality, cardiovascular disease and hypertension, as well as markers of cardiovascular damage including arterial stiffness and uraemic cardiomyopathy. We also discuss the similarities and differences between the pathological reduction in renal function that occurs in CKD, and the reduction in renal function that occurs because of a donor nephrectomy. Kidney donors perform an altruistic act that benefits individual patients as well as the wider society. They deserve to have high-quality evidence on which to make informed decisions.
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Affiliation(s)
- Charles J Ferro
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Renal Medicine, Queen Elizabeth Hospital, Birmingham, UK
| | - Jonathan N Townend
- Institute of Cardiovascular Sciences, University of Birmingham, UK
- Department of Cardiology, Queen Elizabeth Hospital, Birmingham, UK
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13
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Kang E, Park S, Park J, Kim Y, Park M, Kim K, Kim HJ, Han M, Cho JH, Lee JP, Lee S, Kim SW, Park SM, Chae DW, Chin HJ, Kim YC, Kim YS, Choi I, Lee H. Long-term risk of all-cause mortality in live kidney donors: a matched cohort study. Kidney Res Clin Pract 2021; 41:102-113. [PMID: 34781640 PMCID: PMC8816409 DOI: 10.23876/j.krcp.21.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Accepted: 06/21/2021] [Indexed: 11/04/2022] Open
Abstract
Background Long-term outcomes of live kidney donors remain controversial, although this information is crucial for selecting potential donors. Thus, this study compared the long-term risk of all-cause mortality between live kidney donors and healthy control. Methods We performed a retrospective cohort study including donors from seven tertiary hospitals in South Korea. Persons who underwent voluntary health screening were included as controls. We created a matched control group considering age, sex, era, body mass index, baseline hypertension, diabetes, estimated glomerular filtration rate, and dipstick albuminuria. The study outcome was progression to end-stage kidney disease (ESKD), and all-cause mortality as identified in the linked claims database. Results We screened 1,878 kidney donors and 78,115 health screening examinees from 2003 to 2016. After matching, 1,701 persons remained in each group. The median age of the matched study subjects was 44 years, and 46.6% were male. Among the study subjects, 2.7% and 16.6% had underlying diabetes and hypertension, respectively. There were no ESKD events in the matched donor and control groups. There were 24 (1.4%) and 12 mortality cases (0.7%) in the matched donor and control groups, respectively. In the age-sex adjusted model, the risk for all-cause mortality was significantly higher in the donor group than in the control group. However, the significance was not retained after socioeconomic status was included as a covariate (adjusted hazard ratio, 1.82; 95% confidence interval, 0.87-3.80). Conclusion All-cause mortality was similar in live kidney donors and matched non-donor healthy controls with similar health status and socioeconomic status in the Korean population.
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Affiliation(s)
- Eunjeong Kang
- Department of Internal Medicine, Ewha Womans University Seoul Hospital, Ewha Womans University College of Medicine, Seoul, Republic of Korea
| | - Sehoon Park
- Department of Biomedical Science, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jina Park
- Department of Biostatistics, Korea University College of Medicine, Seoul, Republic of Korea
| | - Yaerim Kim
- Department of Internal Medicine, Keimyung University Dongsan Hospital, Daegu, Republic of Korea
| | - Minsu Park
- Department of Statistics, Keimyung University, Daegu, Republic of Korea
| | - Kwangsoo Kim
- Transdisciplinary Department of Medicine & Advanced Technology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Hyo Jeong Kim
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Miyeun Han
- Department of Internal Medicine, Hallym University Hangang Sacred Heart Hospital, Seoul, Republic of Korea
| | - Jang-Hee Cho
- Department of Internal Medicine, Kyungpook National University Hospital, Daegu, Republic of Korea
| | - Jung Pyo Lee
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Sik Lee
- Department of Internal Medicine, Jeonbuk National University Hospital, Jeonju, Republic of Korea
| | - Soo Wan Kim
- Department of Internal Medicine, Chonnam National University Hospital, Gwangju, Republic of Korea
| | - Sang Min Park
- Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Dong-Wan Chae
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Ho Jun Chin
- Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Republic of Korea
| | - Yong Chul Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Yon Su Kim
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Insun Choi
- Division of Healthcare Technology Assessment Research, National Evidence-based Healthcare Collaborating Agency, Seoul, Republic of Korea
| | - Hajeong Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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14
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Hori S, Tanaka N, Tomizawa M, Yoneda T, Shimada K, Nishimura N, Nakai Y, Miyake M, Torimoto K, Itami H, Fujii T, Minamiguchi K, Fujimoto K. Clinical Impact of Subclinical Interstitial Fibrosis or Tubular Atrophy in 1-Hour Allograft Biopsy for Remnant Renal Function in Living Kidney Donors: A Prospective Observational Study. Transplant Proc 2021; 53:2833-2840. [PMID: 34756468 DOI: 10.1016/j.transproceed.2021.09.018] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 09/22/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Preservation of remnant renal function (RRF) is one of the major concerns among living kidney donors (LKDs). A comprehensive assessment is needed to predict the RRF. In this prospective study, we investigated the roles of histologic findings from a 1-hour allograft biopsy in predicting the RRF. METHODS Our prospective study included 116 LKDs who underwent donor nephrectomy (DN) at our institute. Clinical and radiographic data were obtained from their medical charts. Renal volume parameters were calculated using the preoperative computed tomographic images in the volume analyzer SYNAPSE VINCENT image analysis system. Tissues obtained from allograft biopsy were examined. RRF was defined as the estimated glomerular filtration rate (eGFR) 12 months after DN. RESULTS Of 116 LKDs, 95 were finally evaluated. The median age of the LKDs at DN and the preoperative eGFR were 57 years and 80.0 mL/min/1.73 m2, respectively. In the histologic analysis, 68 allografts (71.6%) had nonspecific findings involving the glomerulus, vessel, and tubulointerstitium. Interstitial fibrosis or tubular atrophy (IF/TA) was the only significant predictive factor for RRF (P = .039). No significant association was found between renal volume parameters and IF/TA, whereas remnant renal volume adjusted by body weight (RRV/BW) tended to be relatively correlated with IF/TA (P = .072). Furthermore, LKDs with subclinical IF/TA tended to have decreased RRV/BW compared with those without subclinical IF/TA (P = .088). CONCLUSIONS Our findings suggested that the presence of IF/TA could be a predictive factor for RRF after DN. Further research establishing the predictive model for RRF is warranted to improve the outcomes of LKDs.
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Affiliation(s)
- Shunta Hori
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Nobumichi Tanaka
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan.
| | - Mitsuru Tomizawa
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tatsuo Yoneda
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Keiji Shimada
- Department of Pathology, Nara City Hospital, 1-50-1 Higashikidera-cho, Nara, Nara 630-8305, Japan
| | - Nobutaka Nishimura
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Yasushi Nakai
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Makito Miyake
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kazumasa Torimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Hiroe Itami
- Department of Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Tomomi Fujii
- Department of Pathology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kiyoyuki Minamiguchi
- Department of Radiology and Nuclear Medicine, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
| | - Kiyohide Fujimoto
- Department of Urology, Nara Medical University, 840 Shijo-cho, Kashihara, Nara 634-8522, Japan
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15
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Abstract
PURPOSE OF REVIEW Living kidney donation has been an established practice for many years. Although studies from the past decade have uncovered risks to the donor, living kidney donation is still promoted. In this review, the most recent studies are summarized. RECENT FINDINGS Retrospective studies with long follow-up have detected an increased risk of hypertension among donors. Donors with hypertension at the time of donation may be at increased risk of adverse outcomes, but results differ. Recent studies have not found increased long-term mortality, but follow-up is short and control groups are of different quality. SUMMARY In all, the most recent findings more or less corroborate previous knowledge in the field of living donation. There is still a need for new studies on mortality with appropriate control groups and long enough follow-up.
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16
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Park JJ, Kim K, Choi JY, Shim SR, Kim JH. Long-term mortality of living kidney donors: a systematic review and meta-analysis. Int Urol Nephrol 2021; 53:1563-1581. [PMID: 33959847 DOI: 10.1007/s11255-021-02854-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Accepted: 04/11/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND To date, several studies have reported inconsistent findings regarding the mortality risk faced by living kidney donors and controls. Our study assessed the methodological quality of previous studies and performed an updated meta-analysis of the mortality risk. METHODS Comprehensive literature searches were conducted involving the PubMed, Embase, and Cochrane databases through September 2020. The search terms used included 'living donor' and 'kidney transplantation' and 'kidney donor' and 'mortality' or 'death' or 'survival'. We evaluated the risk of bias in such studies using ROBINS-I tool. Mortality risk was analyzed using OR and HR. RESULTS The qualitative review involved 18 studies and the meta-analysis included nine studies. We identified 3 studies with an overall risk of bias rated as "Low", 2 studies rated as "Moderate", 8 studies rated as "Serious", and 5 studies rated as "Critical". The pooled overall mortality risk in the meta-analysis was 0.984 (95% CI: 0.743, 1.302). In the subgroup analysis of HR and OR, the summary effect estimates did not reach statistical significance. The meta-regression analysis revealed that the donor group of more than 60,000 (1.836, 95% CI: 0.371, 6.410) carried a significantly high mortality risk compared with the donor group of less than 60,000 (0.810, 95% CI: 0.604, 1.086) (P = 0.007). The number of total patients was associated with slightly elevated mortality risks (0.796 for < 10,000, 0.809 for 10,000-60,000, and 1.852 for > 60,000; P < .054). CONCLUSIONS Current evidence based on this systematic review suggests that the methodology of previous studies was inconsistent and also carried a high risk in several aspects. Updated meta-analysis showed that the mortality risk was not significantly different. Future studies with well-designed methodology are necessary.
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Affiliation(s)
- Jae Joon Park
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea
| | - Kyeongmin Kim
- INTO Newton A-Level, University of East Anglia, Norwich, UK
| | - Jin Yong Choi
- Department of Surgery, Myongji Hospital, Goyang, Korea
| | - Sung Ryul Shim
- Department of Preventive Medicine, Korea University College of Medicine, Anamdong 5Ga, Seongbuk-gu, Seoul, 136-701, Korea.
| | - Jae Heon Kim
- Department of Urology, Soonchunhyang University Hospital, Soonchunhyang University College of Medicine, 59 Daesagwan-ro, Yongsan-gu, Seoul, 04401, Korea.
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Munch P, Christiansen CF, Birn H, Erikstrup C, Nørgaard M. Is the risk of cardiovascular disease increased in living kidney donors? A Danish population-based cohort study. Am J Transplant 2021; 21:1857-1865. [PMID: 33128805 DOI: 10.1111/ajt.16384] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Revised: 10/16/2020] [Accepted: 10/20/2020] [Indexed: 01/25/2023]
Abstract
Reduced renal function is associated with cardiovascular disease (CVD); however, how living donor nephrectomy affects the risk of CVD remains controversial. We conducted a nationwide cohort study including living kidney donors in Denmark from 1996 to 2018 to assess the risk of hypertension, atrial fibrillation/flutter (AF), major adverse cardiovascular events (MACE; composite of myocardial infarction, ischemic stroke, and death) and death after living kidney donation. As comparisons we identified: a cohort of healthy individuals from the general population and an external blood donor cohort. We followed kidney donors (1,103 when compared with the general population cohort; 1,007 when compared with blood donors) for a median of 8 years. Kidney donors had an increased risk of initiating treatment for hypertension when compared with blood donors (standardized incidence ratio [SIR], 1.40; 95% confidence interval [CI], 1.17-1.66) but they did not have increased risk of MACE neither when compared with the general population cohort (hazard ratio, 0.68; 95% CI, 0.52-0.89) nor with blood donors (SIR, 1.17; 95% CI, 0.88-1.55). Neither did they have increased risks of AF and death. Thus, living kidney donation may be associated with increased risk of hypertension; however, we did not identify increased risks of CVD or death.
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Affiliation(s)
- Philip Munch
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
| | | | - Henrik Birn
- Department of Renal Medicine, Aarhus University Hospital, Aarhus, Denmark.,Department of Biomedicine, Aarhus University, Aarhus, Denmark
| | - Christian Erikstrup
- Department of Clinical Immunology, Aarhus University Hospital, Aarhus, Denmark
| | - Mette Nørgaard
- Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus, Denmark
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18
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Franquet Q, Matillon X, Terrier N, Rambeaud JJ, Crouzet S, Long JA, Fassi-Fehri H, Codas-Duarte R, Poncet D, Jouve T, Noble J, Malvezzi P, Rostaing L, Descotes JL, Badet L, Fiard G. The Mayo Adhesive Probability score can help predict intra- and postoperative complications in patients undergoing laparoscopic donor nephrectomy. World J Urol 2020; 39:2775-2781. [PMID: 33175210 DOI: 10.1007/s00345-020-03513-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 10/27/2020] [Indexed: 11/28/2022] Open
Abstract
PURPOSE Living donor nephrectomy is a high-stake procedure involving healthy individuals, therefore every effort should be made to define each patient's individualized risk and improve potential donors' information. The aim of this study was to evaluate the interest of the Mayo adhesive probability (MAP) score, an imaging-based score initially designed to estimate the risk of adherent perinephric fat in partial nephrectomy, to predict intra- and postoperative complications of living donor nephrectomy. MATERIALS AND METHODS We retrospectively reviewed the imaging, clinical, and follow-up data of 452 kidney donors who underwent laparoscopic donor nephrectomy in two academic centers. RESULTS Imaging and follow-up data were available for 307 kidney donors, among which 44 (14%) had a high MAP score (≥ 3). Intraoperative difficulties were encountered in 50 patients (16%), including difficult dissection (n = 35) and bleeding (n = 17). Conversion to open surgery was required for 13 patients (4.2%). On multivariate analysis, a MAP score ≥ 3 was significantly associated with the risk of intraoperative difficulty [OR 14.12 (5.58-35.7), p < 0.001] or conversion to open surgery [OR 18.96 (3.42-105.14), p = 0.0042]. Postoperative complications were noted in 99 patients (32%), including 12 patients (3.9%) with Clavien-Dindo grade III-IV complications. On multivariate analysis, a high MAP score was also associated with the risk of postoperative complications [OR 2.55 (1.20-5.40), p = 0.01]. CONCLUSIONS In this retrospective bicentric study, a high MAP score was associated with the risk of intra- and postoperative complications of laparoscopic donor nephrectomy. The MAP score appears of interest in the living donor evaluation process to help improve donors' information and outcomes.
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Affiliation(s)
- Quentin Franquet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Xavier Matillon
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Nicolas Terrier
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Jean-Jacques Rambeaud
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Sebastien Crouzet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Jean-Alexandre Long
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Hakim Fassi-Fehri
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Ricardo Codas-Duarte
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Delphine Poncet
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France
| | - Thomas Jouve
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Johan Noble
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Paolo Malvezzi
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Lionel Rostaing
- Department of Nephrology, Hemodialysis, Apheresis and Kidney Transplantation, Grenoble Alpes University Hospital, Grenoble, France
| | - Jean-Luc Descotes
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France.,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France
| | - Lionel Badet
- Department of Urology and Transplantation, Hôpital Edouard Herriot, Hospices Civils de Lyon, Lyon, France
| | - Gaelle Fiard
- Department of Urology and Kidney Transplantation, Grenoble Alpes University Hospital, CS 10217, 38043, Grenoble Cedex 9, France. .,Université Grenoble Alpes, CNRS, Grenoble INP, TIMC-IMAG, 38000, Grenoble, France.
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