You might remember Mjoen from his prior paper wherein he concluded that after the age of 60, living kidney donors began dying off at a much faster rate than their well-matched, two-kidneyed cohorts.
This time his succinct conclusion is this:
Thus, kidney donors are at increased long-term risk for ESRD, cardiovascular, and all-cause mortality compared with a control group of non-donors who would have been eligible for donation.
Norway has a living donor registry, so they have info on *all* their living kidney donors, all the way back to 1963. The U.S., by comparison, has no identifying info on any kidney donor prior to 1994, and has no useful information over six-weeks past donation. Oops.
In Mjoen’s words:
Follow-up studies of living organ donors have not reported increased cardiovascular and all-cause mortality, but results may have been confounded by selection bias in the control groups… Most published studies have used unselected general populations as the control group, skewing results in favor of the donor cohorts as controls with coexisting medical conditions such as cardiovascular disease, malignancy, diabetes, hypertension, and chronic kidney disease were included that would have made them ineligible for kidney donation.
Median follow-up time was 15.1 years for LKDs and 24.9 years for the well-matched control group.
During the observation period, there were 224 deaths among 1901 kidney donors from the initial inclusion group, 68 (30.4%) of which were due to cardiovascular disease. There were 2425 deaths among the 32,621 controls, 688 (28.4%) of which were due to cardiovascular disease.
Median time from donation to end-stage renal disease was 18.7 years (10.3-24.3)
The crude incidence of ESRD in donors was 302 per million person-years. The overall incidence rate for development of ESRD in Norway is about 100 per million per person-year.
Three studies have included control groups selected to have comparable health status to the living donors, and each of these demonstrated no increase in cardiovascular disease or mortality over a follow-up time of approximately 6 years….Donation was not found to be associated with an increase in all-cause mortality. We also observed no increase in all-cause mortality during the initial 5–10 years after donation, but thereafter the survival curves began to deviate.
In our study, the donors had a substantially increased risk for developing ESRD compared with selected controls. The causes of ESRD were different in donors and controls. Seven out of the nine donors requiring renal replacement therapy had a primary renal disease. This was less common in controls.
Aw, but don’t worry:
We have, as one of the first transplant centers worldwide, strongly advocated this practice for more than four decades. Our findings will not change our opinion in promoting live-kidney donation.
Reinterpreted: As long as we off-handedly mention the risk during evaluation, it’s not really our problem.
Mjøen, G., Hallan, S., Hartmann, A., Foss, A., Midtvedt, K., Øyen, O., Reisæter, A., Pfeffer, P., Jenssen, T., Leivestad, T., Line, P., Øvrehus, M., Dale, D., Pihlstrøm, H., Holme, I., Dekker, F., & Holdaas, H. (2013). Long-term risks for kidney donors Kidney International, 86 (1), 162-167 DOI: 10.1038/ki.2013.460