There’s been a lot of discussion and debate about the long-term risks of living kidney donation, especially the increased risk of kidney disease and failure. While we have some preliminary numbers on living kidney donors who have been waitlisted in need of their own kidney transplant, we have nothing approaching real or comprehensive data on risk or incidence.
Making things more complicated were two studies, both published in 2010, one by Segev and one by Ibrahim, that the media and transplant industry have misconstrued as concluding that living kidney donation does not increase one’s risk of kidney disease or kidney failure. Neither of these studies draw that conclusion, nor could they, given their respective data sets.
But now we have this, presented at the American Transplant Congress 2013:
Limitations to assessing the long-term risk of complications following live kidney donation include the difficulty of matching appropriate healthy, non-donor controls for comparison. Historically, the risk of developing ESRD after live kidney donation has been assessed, as it compared live kidney donors with the general population. This strategy may be misleading, as the general population tends to be less healthy than the carefully screened live kidney donor population.
To address this problem, Muzaale and colleagues used an algorithm that included age, gender, race, education, body mass index, systolic blood pressure, and smoking history to generate controls from National Health and Nutrition Examination Survey (NHANES) data. Kidney donors (n = 96,217) from the Organ Procurement and Transplantation Network (OPTN) reports were matched to these generated controls. The incidence of ESRD at 15 years was eightfold higher for live kidney donors (0.31%) than for healthy matched controls (0.04%). Black donors had the highest incidence of ESRD (0.75%), and white donors had the lowest incidence of ESRD (0.23%).
I’d like to provide more detail here, but being that this was an oral presentation at a conference, I can’t. If the findings ever do make it to print, I doubt they’ll be given the fanfare of the two authors’ articles I cited above. After all, it doesn’t quite fit into that “yes, give us your kidneys, it’ll be great” narrative, does it?
Muzaale A, Massie A, Wainright J, McBride M, Wang M, Segev D. Long-term risk of ESRD attributable to live kidney donation: matching with healthy non-donors. Presented at the 2013 American Transplant Congress; May 18–22, 2013; Seattle, Washington. Abstract 565.