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Massey EK, Rule AD, Matas AJ. Living Kidney Donation: A Narrative Review of Mid- and Long-term Psychosocial Outcomes. Transplantation 2024:00007890-990000000-00794. [PMID: 38886889 DOI: 10.1097/tp.0000000000005094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
Living kidney donors make a significant contribution to alleviating the organ shortage. The aim of this article is to provide an overview of mid- and long-term (≥12 mo) living donor psychosocial outcomes and highlight areas that have been understudied and should be immediately addressed in both research and clinical practice. We conducted a narrative review by searching 3 databases. A total of 206 articles were included. Living donors can be divided into those who donate to an emotionally or genetically related person, the so-called directed donors, or to an emotionally or genetically unrelated recipient, the so-called nondirected donors. The most commonly investigated (bio)psychosocial outcome after living donation was health-related quality of life. Other generic (bio)psychological outcomes include specific aspects of mental health such as depression, and fatigue and pain. Social outcomes include financial and employment burdens and problems with insurance. Donation-specific psychosocial outcomes include regret, satisfaction, feelings of abandonment and unmet needs, and benefits of living kidney donation. The experience of living donation is complex and multifaceted, reflected in the co-occurrence of both benefits and burden after donation. Noticeably, no interventions have been developed to improve mid- or long-term psychosocial outcomes among living donors. We highlight areas for methodological improvement and identified 3 areas requiring immediate attention from the transplant community in both research and clinical care: (1) recognizing and providing care for the minority of donors who have poorer long-term psychosocial outcomes after donation, (2) minimizing donation-related financial burden, and (3) studying interventions to minimize long-term psychosocial problems.
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Affiliation(s)
- Emma K Massey
- Erasmus Medical Center Transplant Institute, University Medical Center Rotterdam, Department of Internal Medicine, Rotterdam, Zuid Holland, the Netherlands
| | - Andrew D Rule
- Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN
| | - Arthur J Matas
- Department of Surgery, Transplantation Division, University of Minnesota, Minneapolis, MN
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Pippias M, Skinner L, Noordzij M, Reisæter AV, Abramowicz D, Stel VS, Jager KJ. Pregnancy after living kidney donation, a systematic review of the available evidence, and a review of the current guidance. Am J Transplant 2022; 22:2360-2380. [PMID: 35716049 PMCID: PMC9804926 DOI: 10.1111/ajt.17122] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Revised: 05/18/2022] [Accepted: 06/09/2022] [Indexed: 01/25/2023]
Abstract
Understanding and communicating the risk of pregnancy complications post-living kidney donation is imperative as the majority of living kidney donors (LKD) are women of childbearing age. We aimed to identify all original research articles examining complications in post-donation pregnancies and compared the quality and consistency of related guidelines. We searched Embase, MEDLINE, PubMed, society webpages, and guideline registries for English-language publications published up until December 18, 2020. Ninety-three articles were screened from which 16 studies were identified, with a total of 1399 post-donation pregnancies. The outcome of interest, post-donation pregnancy complications, was not calculable, and only a narrative synthesis of the evidence was possible. The absolute risk of pre-eclampsia increased from ~1%-3% pre-donation (lower than the general population) to ~4%-10% post-donation (comparable to the general population). The risks of adverse fetal and neonatal outcomes were no different between post-donation and pre-donation pregnancies. Guidelines and consensus statements were consistent in stating the need to inform LKDs of their post-donation pregnancy risk, however, the depth and scope of this guidance were variable. While the absolute risk of pregnancy complications remains low post-donation, a concerted effort is required to better identify and individualize risk in these women, such that consent to donation is truly informed.
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Affiliation(s)
- Maria Pippias
- Bristol Medical School: Population Health SciencesUniversity of BristolBristolUK,North Bristol NHS Trust, Renal UnitBristolUK
| | - Laura Skinner
- North Bristol NHS Trust, Renal UnitBristolUK,Bristol Medical School: Translational Health SciencesUniversity of BristolBristolUK
| | - Marlies Noordzij
- Department of Internal MedicineUniversity Medical Center GroningenGroningenThe Netherlands
| | | | | | - Vianda S. Stel
- ERA Registry, Department of Medical InformaticsAmsterdam Public Health Research Institute, Amsterdam UMC‐Location AMC, University of AmsterdamAmsterdamThe Netherlands
| | - Kitty J. Jager
- ERA Registry, Department of Medical InformaticsAmsterdam Public Health Research Institute, Amsterdam UMC‐Location AMC, University of AmsterdamAmsterdamThe Netherlands
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Zeuschner P, Stöckle M, Peters R, Miller K, Liefeldt L, Halleck F, Budde K, Hennig L, Friedersdorff F. Does the Side Matter? A Retrospective Cohort Study Comparing Left and Right Pure Laparoscopic Donor Nephrectomies. Urol Int 2021; 105:1076-1084. [PMID: 34515246 DOI: 10.1159/000517882] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 05/31/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVES Right laparoscopic donor nephrectomy (RLDN) is no longer regarded inferior to left LDN (LLDN). However, this knowledge is based on many studies suffering from inherent learning curves, center-specific imbalances, and different laparoscopic techniques. METHODS Pure LDNs at a high-volume referral center from 2011 to 2016 were retrospectively analyzed. Patient, graft characteristics, outcomes of LDNs, and corresponding open kidney transplantations were compared between LLDN and RLDN including a follow-up. RESULTS 160 (78.4%) LLDNs and 44 (21.6%) RLDNs only differed regarding graft characteristics, as more right grafts had multiple veins (34.1 vs. 6.9%, p < 0.001) and worse scintigraphic function (44 vs. 51%, p < 0.001). RLDNs were shorter (201 vs. 220 min, p = 0.032) with longer warm ischemia time (165 vs. 140 s, p < 0.001), but left grafts were transplanted faster (160 vs. 171 min, p = 0.048). Recipients of right kidneys had more postoperative complications (grade 3: 25.6 vs. 11.3%, p = 0.020). At a follow-up of 45 (range 6-79) months, neither the kidney function, nor death-censored graft (5-year: LLDN 89 vs. 92%, p = 0.969) and patient survival (5-year: LLDN 95 vs. 98%, p = 0.747) differed. CONCLUSIONS Pure LLDN and RLDN can have different outcomes at high-volume centers, especially higher complications for recipients of right grafts. However, long-term function and graft survival are the same irrespective of the chosen side.
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Affiliation(s)
- Philip Zeuschner
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Michael Stöckle
- Department of Urology and Pediatric Urology, Saarland University, Homburg/Saar, Germany
| | - Robert Peters
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Kurt Miller
- Department of Urology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Fabian Halleck
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Linda Hennig
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Nephrology, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humbold-Universität zu Berlin, Berlin Institute of Health, Berlin, Germany.,Department of Urology, Evangelisches Krankenhaus Königin Elisabeth Herzberge, Berlin, Germany
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Zeuschner P, Siemer S, Stöckle M, Saar M. [The first 50 robot-assisted donor nephrectomies : Lessons learned]. Urologe A 2020; 59:1512-1518. [PMID: 32780177 PMCID: PMC7721693 DOI: 10.1007/s00120-020-01302-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
Hintergrund Die minimal-invasive Donornephrektomie (DN) ist inzwischen operativer Standard, bezüglich der Rolle von roboterassistierten Verfahren gibt es bisher keinen Konsens. Fragestellung Die ersten 50 transperitonealen roboterassistierten Donornephrektomien (RDN) einer urologischen Universitätsklinik in Deutschland wurden retrospektiv ausgewertet. Material und Methoden Patientencharakteristika, intra- und postoperative Parameter wurden erfasst und die Nierenfunktion in einem 5‑jährigen Follow-up ausgewertet. Signifikante Prädiktoren für die Nierenfunktion bei Entlassung und ein Jahr postoperativ wurden in einem multivariablen Regressionsmodell bestimmt. Ergebnisse Die RDN hat exzellente Ergebnisse mit niedriger Komplikationsrate, kurzer warmer (WIZ) und kalter Ischämiezeit (KIZ) sowie geringem Blutverlust und kurzer Patientenverweildauer. Die Seite der Nierenentnahme hat hierauf keine Auswirkungen. Nach RDN sind etwa 50 % der Spender formal niereninsuffizient, was aber zumeist ohne Relevanz ist, weil sich die Nierenfunktion der Spender im Follow-up nicht weiter verschlechtert. Die postoperative Nierenfunktion lässt sich bei der RDN mithilfe der präoperativen eGFR (errechnete glomeruläre Filtrationsrate) und dem Spenderalter sehr gut vorhersagen. Schlussfolgerungen Die robotische DN stellt eine sehr gute Alternative zu anderen minimal-invasiven Operationsverfahren dar, die von Beginn an exzellente operative Ergebnisse ermöglicht.
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Affiliation(s)
- Philip Zeuschner
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland.
| | - Stefan Siemer
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - Michael Stöckle
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
| | - Matthias Saar
- Klinik für Urologie und Kinderurologie, Universitätsklinikum des Saarlandes und Medizinische Fakultät der Universität des Saarlandes, Kirrberger Straße 100, 66421, Homburg/Saar, Deutschland
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Mang J, Hennig L, Biernath N, Liefeldt L, Bichmann A, Ralla B, Maxeiner A, Peters R, Cash H, Budde K, Friedersdorff F. Is a Retroaortic Vein a Risk Factor in Laparoscopic Living Donor Nephrectomy? Urol Int 2020; 104:641-645. [PMID: 32417839 DOI: 10.1159/000507642] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2020] [Accepted: 02/27/2020] [Indexed: 12/17/2022]
Abstract
INTRODUCTION In living donor transplantation choosing the right donor and donor side for laparoscopic donor nephrectomy is a challenging task in clinical practice. Knowledge about anomalies in renal blood supply are crucial to evaluate the feasibility of the operative procedure. Few data so far exist whether the existence of a retroaortic left renal vein has an impact on living kidney transplantation outcome for donor and recipient. MATERIALS AND METHODS We retrospectively analyzed 221 patients who underwent laparoscopic living donor nephrectomy between 2011 and 2017 for existence of a retroaortic left renal vein. Clinical characteristics and operative outcomes for donors and recipients were analyzed. RESULTS 221 patients underwent donor nephrectomy between 2011 and 2017; 11 patients (4.98%) showed the feature of a retroaortic left renal vein, and in 8 patients (72.7%) out of those 11 the left kidney was chosen for transplantation. Mean preoperative serum creatinine was 0.77 (0.49-0.98) mg/dL and 1.28 (0.97-1.64) mg/dL at discharge. In recipients mean serum creatinine preoperatively, after 1 week, 1 month,1 year, 2 and 3 years of follow-up was 10.36 (6.09-20.77) mg/dL, 1.71 (0.67-2.72), 1.33 (0.70-1.89), 1.31 (0.95-2.13), 1.31 (0.98-2.13) and 1.33 (1.03-1.84), respectively. Neither donors nor recipients suffered from any operative complications. CONCLUSIONS Laparoscopic living donor nephrectomy of a left kidney with retroaortic renal vein is safe for the donor, without limitation in the outcome for the recipient.
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Affiliation(s)
- Josef Mang
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Linda Hennig
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Nadine Biernath
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Lutz Liefeldt
- Department of Nephrology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Anna Bichmann
- Department of Anesthesiology and Operative Intensive Care Medicine, Campus Charité Mitte, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Bernhard Ralla
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Andreas Maxeiner
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Robert Peters
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Hannes Cash
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Klemens Budde
- Department of Nephrology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany
| | - Frank Friedersdorff
- Department of Urology, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Germany,
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