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Vock DM, Helgeson ES, Mullan AF, Issa NS, Sanka S, Saiki AC, Mathson K, Chamberlain AM, Rule AD, Matas AJ. The Minnesota attributable risk of kidney donation (MARKD) study: a retrospective cohort study of long-term (> 50 year) outcomes after kidney donation compared to well-matched healthy controls. BMC Nephrol 2023; 24:121. [PMID: 37127560 PMCID: PMC10152793 DOI: 10.1186/s12882-023-03149-7] [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: 03/01/2023] [Accepted: 04/01/2023] [Indexed: 05/03/2023] Open
Abstract
BACKGROUND There is uncertainty about the long-term risks of living kidney donation. Well-designed studies with controls well-matched on risk factors for kidney disease are needed to understand the attributable risks of kidney donation. METHODS The goal of the Minnesota Attributable Risk of Kidney Donation (MARKD) study is to compare the long-term (> 50 years) outcomes of living donors (LDs) to contemporary and geographically similar controls that are well-matched on health status. University of Minnesota (n = 4022; 1st transplant: 1963) and Mayo Clinic LDs (n = 3035; 1st transplant: 1963) will be matched to Rochester Epidemiology Project (REP) controls (approximately 4 controls to 1 donor) on the basis of age, sex, and race/ethnicity. The REP controls are a well-defined population, with detailed medical record data linked between all providers in Olmsted and surrounding counties, that come from the same geographic region and era (early 1960s to present) as the donors. Controls will be carefully selected to have health status acceptable for donation on the index date (date their matched donor donated). Further refinement of the control group will include confirmed kidney health (e.g., normal serum creatinine and/or no proteinuria) and matching (on index date) of body mass index, smoking history, family history of chronic kidney disease, and blood pressure. Outcomes will be ascertained from national registries (National Death Index and United States Renal Data System) and a new survey administered to both donors and controls; the data will be supplemented by prior surveys and medical record review of donors and REP controls. The outcomes to be compared are all-cause mortality, end-stage kidney disease, cardiovascular disease and mortality, estimated glomerular filtration rate (eGFR) trajectory and chronic kidney disease, pregnancy risks, and development of diseases that frequently lead to chronic kidney disease (e.g. hypertension, diabetes, and obesity). We will additionally evaluate whether the risk of donation differs based on baseline characteristics. DISCUSSION Our study will provide a comprehensive assessment of long-term living donor risk to inform candidate living donors, and to inform the follow-up and care of current living donors.
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Affiliation(s)
- David M Vock
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200, Minneapolis, MN, 55414, USA
| | - Erika S Helgeson
- Division of Biostatistics, School of Public Health, University of Minnesota, 2221 University Ave SE, Room 200, Minneapolis, MN, 55414, USA.
| | - Aidan F Mullan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Naim S Issa
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Sujana Sanka
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Alison C Saiki
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Kristin Mathson
- Surgery Clinical Trials Office, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Alanna M Chamberlain
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | - Andrew D Rule
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Division of Nephrology and Hypertension, Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Arthur J Matas
- Division of Transplantation, Department of Surgery, University of Minnesota, Minneapolis, MN, USA
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Ambagtsheer F, Haase‐Kromwijk B, Dor FJMF, Moorlock G, Citterio F, Berney T, Massey EK. Global Kidney Exchange: opportunity or exploitation? An ELPAT/ESOT appraisal. Transpl Int 2020; 33:989-998. [PMID: 32349176 PMCID: PMC7540591 DOI: 10.1111/tri.13630] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2020] [Revised: 03/11/2020] [Accepted: 04/24/2020] [Indexed: 12/20/2022]
Abstract
This paper addresses ethical, legal, and psychosocial aspects of Global Kidney Exchange (GKE). Concerns have been raised that GKE violates the nonpayment principle, exploits donors in low- and middle-income countries, and detracts from the aim of self-sufficiency. We review the arguments for and against GKE. We argue that while some concerns about GKE are justified based on the available evidence, others are speculative and do not apply exclusively to GKE but to living donation more generally. We posit that concerns can be mitigated by implementing safeguards, by developing minimum quality criteria and by establishing an international committee that independently monitors and evaluates GKE's procedures and outcomes. Several questions remain however that warrant further clarification. What are the experiences and views of recipients and donors participating in GKE? Who manages the escrow funds that have been put in place for donor and recipients? What procedures and safeguards have been put in place to prevent corruption of these funds? What are the inclusion criteria for participating GKE centers? GKE provides opportunity to promote access to donation and transplantation but can only be conducted with the appropriate safeguards. Patients' and donors' voices are missing in this debate.
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Affiliation(s)
- Frederike Ambagtsheer
- Department of Internal Medicine, Nephrology & TransplantationErasmus MCRotterdamThe Netherlands
| | | | - Frank J. M. F. Dor
- Imperial College Renal and Transplant CentreHammersmith HospitalLondonUK
- Department of Surgery and CancerImperial CollegeLondonUK
| | - Greg Moorlock
- Warwick Medical SchoolUniversity of WarwickCoventryUK
| | - Franco Citterio
- Renal Transplantation UnitFondazione Policlinico Universitario, A. GemelliRomeItaly
| | - Thierry Berney
- Division of TransplantationUniversity of Geneva HospitalsGenevaSwitzerland
| | - Emma K. Massey
- Department of Internal Medicine, Nephrology & TransplantationErasmus MCRotterdamThe Netherlands
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