1
|
López-Abad A, Prudhomme T, Pecoraro A, Boissier R, Dönmez MI, Piana A, Marco BB, Belmonte M, Serni S, Campi R, Territo A. Can CT or MRI volumetry substitute scintigraphy in living kidney donor evaluation? A systematic review. World J Urol 2024; 42:382. [PMID: 38904679 PMCID: PMC11192666 DOI: 10.1007/s00345-024-05024-y] [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: 11/20/2023] [Accepted: 04/28/2024] [Indexed: 06/22/2024] Open
Abstract
BACKGROUND Current potential living kidney donor's assessment includes functional and anatomical evaluation. Scintigraphy is recommended in some cases and some centers include this test in the donor's protocol. Recent studies advocate for the avoidance of this test as CT or MRI volumetry showed to accurately assess donor's renal function. OBJECTIVE To summarize scientific evidence on image tests for pre-donation and/or post-nephrectomy renal function evaluation. EVIDENCE ACQUISITION This review followed the guidelines set by the European Association of Urology and adhered to PRISMA 2020 recommendations. The protocol was registered in PROSPERO on 10th December 2022 (ID: CRD42022379273). EVIDENCE SYNTHESIS Twenty-one studies met the inclusion criteria after thorough screening and eligibility assessment. According to QUADAS-2, patient selection and flow/timing domains showed a predominant low risk of bias. The correlation between split renal function (SRF) using CT and scintigraphy varied from weak (r = 0.21) to remarkably strong (r = 0.949). Bland-Altman agreement demonstrated moderate to excellent results, with mean differences ranging from -0.06% to 1.76%. The correlation between split renal volume (CT) and estimated glomerular filtration rate (eGFR) at 6 months or 1 year after nephrectomy showed a moderate correlation, with coefficients ranging from 0.708 to 0.83. The correlation between SRF (MRI) and renal scintigraphy reported a moderate correlation, with correlation coefficients of 0.58 and 0.84. MRI and scintigraphy displayed a good agreement, with a 66% agreement observed and mean differences of ± 0.3%. CONCLUSIONS Despite study heterogeneity, MRI or CT-based renal volumetry appears promising compared to scintigraphy, with favorable correlations and agreement.
Collapse
Affiliation(s)
- Alicia López-Abad
- Department of Urology, Virgen de La Arrixaca University Hospital, Murcia, Spain
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Viale San Luca, 50134, Florence, Italy
| | - Thomas Prudhomme
- Department of Urology, Kidney Transplantation and Andrology, Toulouse Rangueil University Hospital, Toulouse, France
| | - Alessio Pecoraro
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Viale San Luca, 50134, Florence, Italy
| | - Romain Boissier
- Department of Urology and Renal Transplantation, Aix-Marseille University, La Conception University Hospital, Marseille, France
| | - Muhammet Irfan Dönmez
- Department of Urology, Istanbul University Istanbul Faculty of Medicine, Istanbul, Turkey
| | - Alberto Piana
- Department of Oncology, Division of Urology, University of Turin, Turin, Italy
| | - Beatriz Bañuelos Marco
- Department of Urology, Kidney Transplantation and Reconstructive Urology, Hospital Universitario Clinico San Carlos, Madrid, Spain
| | - Mario Belmonte
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Viale San Luca, 50134, Florence, Italy
| | - Sergio Serni
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Viale San Luca, 50134, Florence, Italy
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy
| | - Riccardo Campi
- Unit of Urological Robotic Surgery and Renal Transplantation, Careggi Hospital, University of Florence, Viale San Luca, 50134, Florence, Italy.
- Department of Experimental and Clinical Medicine, University of Florence, 50134, Florence, Italy.
| | - Angelo Territo
- Department of Urology, Fundació Puigvert, Autonoma University of Barcelona, Barcelona, Spain
| |
Collapse
|
2
|
Zemla P, Hartmann I, Hruska F, Kral M, Janeckova J, Utikal P, Vidlar A, Krejci K, Bachleda P. Robotic assisted living donor nephrectomy - the first in the Czech Republic. Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub 2024; 168:177-180. [PMID: 37614196 DOI: 10.5507/bp.2023.034] [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: 04/24/2023] [Accepted: 07/19/2023] [Indexed: 08/25/2023] Open
Abstract
INTRODUCTION A kidney transplant is the best method for treating terminal kidney failure. Long-term results of kidney transplants from living donors are significantly better than transplants from dead donors. Living kidney donors are healthy people who undergo a major operation in order to improve the health of another person. Therefore, major emphasis is on safety, low level of invasiveness and a desirable cosmetic effect of the donor nephrectomy. Since 2012, the Department of Urology at the University Hospital in Olomouc has performed 12 kidney harvestings from living donors. The kidney harvesting was conducted using various techniques. CASE REPORT The first robotic assisted kidney harvesting in the Czech Republic was performed in June 2022. The donor was a 57-year-old man who donated his kidney to his 32-year-old daughter. The left kidney was evaluated as suitable for kidney harvesting. The operation took 174 min. The kidney's warm ischemia was 145 s. Based on the Clavien Dindo classification, no 2nd degree or high post-operative complications were recorded. The donor's pre-operative glomerular filtration was 1.63 mL/s. Six months post-operation, it went down to 1.19 mL/s. This represents a 27% decrease. The kidney recipient did not require early dialysis. Six months post-operation, the recipient's glomerular filtration was 2.03 mL/s. CONCLUSION In the hands of experienced professionals and transplantation centres, robotic assisted donor nephrectomy is a feasible and safe option for this operation. It not only provides all the advantages of a laparoscopic operation but it also adds other technical improvements and minimizes intraoperative stress on the surgeon. Currently, the global trend is moving towards increasing the ratio of robotic assisted donor nephrectomies.
Collapse
Affiliation(s)
- Pavel Zemla
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Igor Hartmann
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Frantisek Hruska
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Jana Janeckova
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Utikal
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| | - Ales Vidlar
- Department of Urology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Karel Krejci
- Department of Internal Medicine III - Nephrology, Rheumatology and Endocrinology, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Bachleda
- Department of Surgery II - Vascular and Transplantation Surgery, University Hospital Olomouc, Olomouc, Czech Republic
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Haberal M, Ayvazoglu Soy EH, Akdur A, Alshalabi O, Yildirim S, Moray G, Torgay A. The New Anterior Less Invasive Crescentic Incision for Living Donor Nephrectomy. EXP CLIN TRANSPLANT 2020; 18:543-548. [PMID: 33143599 DOI: 10.6002/ect.2020.0370] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVES Living-donor nephrectomy is a devoted procedure performed in a healthy individual; for these procedures, it is essential to complete the surgery with the lowest possible risk and morbidity and allow donors to regain their normal daily activity. To minimize anatomic and physiologic damage, we modified a surgical technique. Here, we report our experiences with the new anterior less invasive crescentic donor nephrectomy technique. MATERIALS AND METHODS We retrospectively evaluated 728 donor nephrectomy patients who had the new anterior less invasive cresentic incision (n = 224), the classic open (n = 431), or the laparoscopic living-donor nephrectomy (n = 73) procedures. Demographic characteristics, preoperative and postoperative parameters, acute renal graft dysfunction, and firstyear graft and patient survival rates were compared between groups. RESULTS During the operation, the new cresentic incision living-donor nephrectomy allowed a safe and comfortable position for the patient and the anesthesiologist. Also, it procures safe access especially for grefts with multiple vessels. Patients had lower pain scores (P = .010), shorter hospital stays (2.25 vs 3.49 days) than those who received the classic open living-donor nephrectomy. Patients who received laparoscopic living-donor nephrectomy had significantly longer mean operation time (P = .016) and warm ischemia time (P ≤ .001) than those who had the new cresentic incision technique. All groups showed similar rates of first-year survival and delayed graft dysfunction. CONCLUSIONS The new anterior less invasive cresentic incision open-donor nephrectomy approach is a safe, comfortable, effective, and less invasive modification of the living donor nephrectomy. Also, it procures safe access for grefts with multiple vessels.
Collapse
Affiliation(s)
- Mehmet Haberal
- >From the Department of General Surgery, Division of Transplantation, Baskent University, Ankara, Turkey
| | | | | | | | | | | | | |
Collapse
|
5
|
Yearly Trends of Chronic Kidney Disease III Progressions in Living Kidney Donors. Transplant Proc 2019; 51:2539-2542. [PMID: 31447190 DOI: 10.1016/j.transproceed.2019.03.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 03/11/2019] [Accepted: 03/23/2019] [Indexed: 11/22/2022]
Abstract
PURPOSE We aim to see the rate of progression to chronic kidney disease stage III after living donor nephrectomy in a single institution annually. METHODS Between May 2006 and July 2017, a total of 753 living kidney donors who were followed up more than 6 months were enrolled in the study. We divided normal function vs chronic kidney disease III at 6 months postoperatively. We compared the incidence rate of chronic kidney disease stage III annually. For analysis, the entire period was divided into Era 1 (2006-2008), Era 2 (2009-2011), Era 3 (2012-2014), and Era 4 (2015-2017). RESULTS During the period, the incidence of chronic kidney disease stage III was 258 living donors (34.3%). The prevalence of chronic kidney disease stage III was 39.3%, 36.6%, 35.5%, and 29.3% in Era 1, Era 2, Era 3, and Era 4, respectively. The rate of chronic kidney disease stage III incidence serially decreased as the era passed (P = .046). There was no difference in age, smoking status, drinking status, body mass index, preoperative cholesterol, and uric acid among the eras. However, preoperative estimated glomerular filtration rate was 90.86 (SD, 4.12), 94.47 (SD, 16.62), 103.82 (SD, 0.68), and 105.66 (SD, 19.57) mL/min/1.73 m2 in Era 1, Era 2, Era 3, and Era 4, respectively (P = .001). CONCLUSIONS The incidence of chronic kidney disease stage III in living kidney donors for the last 3 years (Era 4) has decreased compared with the past (Era 1 and 2). The reason for this might be the effect of the change in the living donor guideline. Also, pre- and postoperative management method had an effect on renal function at 6 months.
Collapse
|
6
|
Garcia-Ochoa C, Feldman LS, Nguan C, Monroy-Cuadros M, Arnold J, Boudville N, Cuerden M, Dipchand C, Eng M, Gill J, Gourlay W, Karpinski M, Klarenbach S, Knoll G, Lentine KL, Lok CE, Luke P, Prasad GVR, Sener A, Sontrop JM, Storsley L, Treleaven D, Garg AX. Perioperative Complications During Living Donor Nephrectomy: Results From a Multicenter Cohort Study. Can J Kidney Health Dis 2019; 6:2054358119857718. [PMID: 31367455 PMCID: PMC6643179 DOI: 10.1177/2054358119857718] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2019] [Accepted: 04/30/2019] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND While living kidney donation is considered safe in healthy individuals, perioperative complications can occur due to several factors. OBJECTIVE We explored associations between the incidence of perioperative complications and donor characteristics, surgical technique, and surgeon's experience in a large contemporary cohort of living kidney donors. DESIGN Living kidney donors enrolled prospectively in a multicenter cohort study with some data collected retrospectively after enrollment was complete (eg, surgeon characteristics). SETTING Living kidney donor centers in Canada (n = 12) and Australia (n = 5). PATIENTS Living kidney donors who donated between 2004 and 2014 and the surgeons who performed the living kidney donor nephrectomies. MEASUREMENTS Operative and hospital discharge medical notes were collected prospectively, with data on perioperative (intraoperative and postoperative) information abstracted from notes after enrollment was complete. Complications were graded using the Clavien-Dindo system and further classified into minor and major. In 2016, surgeons who performed the nephrectomies were invited to fill an online survey on their training and experience. METHODS Multivariable logistic regression models with generalized estimating equations were used to compare perioperative complication rates between different groups of donors. The effect of surgeon characteristics on the complication rate was explored using a similar approach. Poisson regression was used to test rates of overall perioperative complications between high- and low-volume centers. RESULTS Of the 1421 living kidney donor candidates, 1042 individuals proceeded with donation, where 134 (13% [95% confidence interval (CI): 11%-15%]) experienced 142 perioperative complications (55 intraoperative; 87 postoperative). The most common intraoperative complication was organ injury and the most common postoperative complication was ileus. No donors died in the perioperative period. Most complications were minor (90% of 142 complications [95% CI: 86%-96%]); however, 12 donors (1% of 1042 [95% CI: 1%-2%]) experienced a major complication. No statistically significant differences were observed between donor groups and the rate of complications. A total of 43 of 48 eligible surgeons (90%) completed the online survey. Perioperative complication rates did not vary significantly by surgeon characteristics or by high- versus low-volume centers. LIMITATIONS Operative and discharge reporting is not standardized and varies among surgeons. It is possible that some complications were missed. The online survey for surgeons was completed retrospectively, was based on self-report, and has not been validated. We had adequate statistical power only to detect large effects for factors associated with a higher risk of perioperative complications. CONCLUSIONS This study confirms the safety of living kidney donation as evidenced by the low rate of major perioperative complications. We did not identify any donor or surgeon characteristics associated with a higher risk of perioperative complications. TRIAL REGISTRATIONS NCT00319579: A Prospective Study of Living Kidney Donation (https://clinicaltrials.gov/ct2/show/NCT00319579)NCT00936078: Living Kidney Donor Study (https://clinicaltrials.gov/ct2/show/NCT00936078).
Collapse
Affiliation(s)
- Carlos Garcia-Ochoa
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
| | | | - Christopher Nguan
- Department of Urologic Sciences, The
University of British Columbia, Vancouver, Canada
| | | | - Jennifer Arnold
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
| | - Neil Boudville
- Medical School, The University of
Western Australia, Perth, Australia
| | - Meaghan Cuerden
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
| | - Christine Dipchand
- Division of Nephrology, Department of
Medicine, Dalhousie University, Halifax, NS, Canada
| | - Michael Eng
- Department of Urologic Sciences, The
University of British Columbia, Vancouver, Canada
| | - John Gill
- Division of Nephrology, The University
of British Columbia, Vancouver, Canada
| | - William Gourlay
- Department of Urologic Sciences, The
University of British Columbia, Vancouver, Canada
| | - Martin Karpinski
- Department of Medicine, University of
Manitoba, Winnipeg, Canada
| | | | - Greg Knoll
- Division of Nephrology, Department of
Medicine, Ottawa Hospital Research Institute, ON, Canada
| | - Krista L. Lentine
- Centre for Abdominal Transplantation,
Saint Louis University School of Medicine, MO, USA
| | | | - Patrick Luke
- Department of Urology, Western
University, London, ON, Canada
| | - G. V. Ramesh Prasad
- Division of Nephrology, Department of
Medicine, University of Toronto, ON, Canada
| | - Alp Sener
- Department of Urology, Western
University, London, ON, Canada
| | - Jessica M. Sontrop
- Department of Epidemiology &
Biostatistics, Western University, London, ON, Canada
| | - Leroy Storsley
- Department of Internal Medicine,
University of Manitoba, Winnipeg, Canada
| | - Darin Treleaven
- Division of Nephrology, Department of
Medicine, McMaster University, Hamilton, ON, Canada
| | - Amit X. Garg
- Division of Nephrology, Department of
Medicine, Western University, London, ON, Canada
| | | |
Collapse
|
7
|
Na JC, Park JS, Yoon MG, Lee HH, Yoon YE, Huh KH, Kim YS, Han WK. Delayed Recovery of Renal Function After Donor Nephrectomy. Transplant Proc 2018; 50:1022-1024. [PMID: 29731060 DOI: 10.1016/j.transproceed.2018.01.038] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Many living kidney donors are still at risk of chronic kidney disease (CKD) 1 year after nephrectomy. Although some donors still experience poor renal function, many exhibit delayed recovery of renal function afterwards. We studied the factors related to delayed recovery of renal function in patients with CKD at 1 year after nephrectomy. METHODS Patients who underwent donor nephrectomy from March 2006 to April 2014 with a follow-up creatinine study at 1 month, 6 months, 1 year, and after 3 years of follow-up were included in the study. Age, sex, history of hypertension or diabetes, body mass index, blood pressure, complete blood cell count, preoperative routine serum chemistry, and urine study results were reviewed. RESULTS Among 275 donors, 83 (30.2%) who had an estimated glomerular filtration rate (eGFR) <60 mL/min/1.73 m2 at 1 year of follow-up were included in the study, and the eGFR was observed during a median follow-up of 62.0 months (interquartile range [IQR], 48.9-83.1 months). Those who had improvements in eGFR of >5 mL/min/1.73 m2 were included in the recovery group (n = 48 [57.8%]), and those who did not were included in the nonrecovery group (n = 35 [42.2%]). The preoperative and 1-year follow-up eGFR did not differ significantly between the 2 groups, and the maximum eGFR after 3 years was higher in the recovery group (68.68 mL/min/1.73 m2 [IQR, 61.81-75.64 mL/min/1.73 m2] vs 55.63 mL/min/1.73 m2 [IQR, 51.73-58.29 mL/min/1.73 m2]; P < .001). The recovery group was more likely to have a history of hypertension (4.2% vs 20%; P = .032), a lower body mass index (24.11 kg/m2 [IQR, 22.04-25.20 kg/m2] vs 25.25 kg/m2 [IQR, 23.23-26.44 kg/m2]; P = .01), and a lower preoperative uric acid level (4.7 mg/dL [IQR, 3.8-5.4 mg/dL] vs 5.3 mg/dL [IQR, 4.4-6.2 mg/dL]; P = .031). After multivariate logistic regression analysis, history of hypertension (odds ratio, 0.131; P = .022) and uric acid level (odds ratio, 0.641; P = .036,) remained as significant factors. CONCLUSIONS Although 30.2% of donors had CKD at 1 year after nephrectomy, 57.8% reported improved renal function. Those with a history of hypertension and high preoperative uric acid levels were less likely to have improvements in renal function and required close follow-up.
Collapse
Affiliation(s)
- J C Na
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea
| | - J S Park
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea
| | - M-G Yoon
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea
| | - H H Lee
- Department of Urology, National Health Insurance Service Ilsan Hospital, Goyang-si, Republic of Korea
| | - Y E Yoon
- Department of Urology, Hanyang University College of Medicine, Seoul, Republic of Korea
| | - K H Huh
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - Y S Kim
- Department of Transplantation Surgery, Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Republic of Korea
| | - W K Han
- Department of Urology, Yonsei University College of Medicine, Urological Science Institute, Seoul, Republic of Korea; Brain Korea 21 PLUS Project for Medical Science, Yonsei University, Seoul, Republic of Korea.
| |
Collapse
|
8
|
Benzing C, Hau HM, Kurtz G, Schmelzle M, Tautenhahn HM, Morgül MH, Wiltberger G, Broschewitz J, Atanasov G, Bachmann A, Bartels M. Long-term health-related quality of life of living kidney donors: a single-center experience. Qual Life Res 2015; 24:2833-42. [PMID: 26149394 DOI: 10.1007/s11136-015-1027-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/22/2015] [Indexed: 11/27/2022]
Abstract
PURPOSE Over the last few years, the evaluation of the health-related quality of life (HRQoL) of living kidney donors (LKD) has become of particular interest. The present study sought to evaluate the physical and mental HRQoL after kidney removal. The clinical and paraclinical course of these patients was examined, and the impact of preoperative donor evaluation, donor nephrectomy, and surgical recovery was evaluated. These data were compared with reference data of the general population. METHODS Between 1998 and 2010, 72 living kidney donations were performed at our institution. To assess the HRQoL, two questionnaires-the Short Form 36 (SF-36) and a special LKD questionnaire-were sent to all 72 living donors. The records of the follow-up examinations of all 72 donors were retrospectively analyzed in order to assess the clinical and paraclinical data after kidney donation. RESULTS Out of 72 donors, 55 (76.4 %) responded to the questionnaires. There was no change in systolic and diastolic blood pressure during the 7-year follow-up (p > 0.05). Mild proteinuria (>150 mg/l) was observed in six cases. Kidney donors had a higher HRQoL compared to the general population with mean values of the physical and mental summation scale (PCS and MCS, respectively) being 51.3 (SD = 7.6) and 50.6 (SD = 8.1). Peri- or postoperative complications were associated with lower values for physical function and physical component summary (PCS) (p < 0.05). DISCUSSION Living donor kidney transplantation appears to be safe for donors. The HRQoL is excellent. To ensure a positive outcome for donors, a good clinical evaluation of potential donors is essential.
Collapse
Affiliation(s)
- Christian Benzing
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Hans-Michael Hau
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Greta Kurtz
- Department of Anesthesiology and Critical Care, Hospital of Mühlacker, Hermann-Hesse-Straße 34, 75417, Mühlacker, Germany
| | - Moritz Schmelzle
- Department of General, Visceral and Transplantation Surgery, Charité-Universitätsmedizin Berlin, Augustenburger Platz 1, Berlin, Germany
| | - Hans-Michael Tautenhahn
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Mehmet Haluk Morgül
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Georg Wiltberger
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Johannes Broschewitz
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Georgi Atanasov
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany
| | - Anette Bachmann
- Section for Nephrology, Department of Endocrinology and Nephrology, University Hospital of Leipzig, Leipzig, Germany
| | - Michael Bartels
- Department of Visceral, Transplantation, Vascular, and Thoracic Surgery, University Hospital of Leipzig, Liebigstraße 20, 04103, Leipzig, Germany.
| |
Collapse
|
9
|
From potential donor to actual donation: does socioeconomic position affect living kidney donation? A systematic review of the evidence. Transplantation 2015; 98:918-26. [PMID: 25250649 DOI: 10.1097/tp.0000000000000428] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
Evidence from Europe, Australia and the United States demonstrates that socioeconomically deprived individuals with advanced chronic kidney disease are less likely to receive a living kidney transplant compared with less deprived individuals. This systematic review focuses on how socioeconomic position (SEP) may influence hypothetical and actual living kidney donors and where appropriate, summarizes the quantitative evidence.In the general population, a higher SEP appears to be associated with an increased 'hypothetical' willingness to be a living kidney donor but with marked heterogeneity in the absolute differences (I = 95.9%, P < 0.001). In a commercial setting, lower SEP motivates people to donate. Outside of this setting, there is no evidence of discordance in the SEP of donors and recipients that would suggest undisclosed financial exchange. There is evidence for a complex interaction between SEP and other variables, such as ethnicity, sex, and the national economic climate. Some evidence suggests that measures to remove financial disincentives to donation are associated with an increase in living donation rates. Future research needs to study how SEP impacts the potential donor population from willingness to donate, progression through donor assessment to actual donor nephrectomy.
Collapse
|
10
|
Bailey PK, Tomson CRV, Ben-Shlomo Y. Study of living kidney donor-recipient relationships: variation with socioeconomic deprivation in the white population of England. Clin Transplant 2013; 27:E327-31. [DOI: 10.1111/ctr.12120] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2013] [Indexed: 11/28/2022]
Affiliation(s)
| | | | - Yoav Ben-Shlomo
- School of Social and Community Medicine; University of Bristol; Bristol; UK
| |
Collapse
|