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Living Donor Research Living Donor Risks Living Kidney Donor

How Many Living Kidney Donors Were Obese Pre-Donation?

47,705 adult living kidney donors as reported to OPTN from 1999 to 2011 were analyzed using their pre-donation BMI (body mass index)

  • 35.6% were normal weight.
  • 40.5% were overweight
  • 18.9% were mildly obese
  • 4.2% were moderate to morbidly obese
  • Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively
  • 63.6% of living kidney donors over the past thirteen years have spanned the overweight to obese categories

 

According to OPTN guidelines, having a BMI greater than 35 kg/m2 is considered a relative contraindication to be a living kidney donor. However, based on a 2007 survey, 20% of transplant centers surveyed excluded those with BMI greater than 40 kg/m2 , 52% excluded donors with BMI greater than 35 kg/m2 , 10% excluded those with BMI over 30 kg/m2 , 12% percent had no policy for exclusion, and 6% excluded based on BMI if they had other cardiovascular risks.

  • Short term outcomes of obese living kidney donors have shown increased wound related complications and longer operative times
  • At five year follow up, Kramer et al found that overweight and obese individuals had 20% and 40% risk of developing chronic kidney disease.
  • Having a higher baseline BMI can serve as an independent risk factor for end stage kidney disease.
  • The long term effects of obesity on the solitary kidney of a kidney donor are still uncertain. This risk factor increases the risk of developing other co-morbid conditions such as diabetes mellitus, hypertension, or even proteinuria which can together compromise the function of their solitary kidney
  • At a mean of 11 year follow up, obese donors had an increased risk of developing hypertension and dyslipidemia.

 

Read the entire article at the link (above). Take care of yourselves.

 
Sachdeva, M. (2015). Weight trends in United States living kidney donors: Analysis of the UNOS database World Journal of Transplantation, 5 (3) DOI: 10.5500/wjt.v5.i3.137

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Advocacy Informed Consent Living Donor Research Living Donor Risks Living Kidney Donor OPTN

63.6% of Living Kidney Donors Are Overweight

An analysis of the OPTN/UNOS database from 1999-2011 reveals that 63.6% of all living kidney donors were either overweight* or obese.

(emphasis mine):

“Overweight and mildly obese kidney donors have increased through time by 12% and 20% every 5 years, respectively “

 

Obesity is associated with numerous health risks, including Type 2 Diabetes and hypertension. According to USRDS, 44% of kidney failure is due to diabetes and another 26% is because of high blood pressure.

And:

“Having a BMI greater than 35 kg/m2 has been associated with slightly longer operative times and overall more peri-opera­tive complications, such as wound complications”

 

If obesity is such a problem, especially in regards to kidney function and health, wouldn’t OPTN have some sort of policy on the matter? (emphasis mine again)

 

According to OPTN guidelines, having a BMI greater than 35 kg/m2 is considered a relative contraindication to be a living kidney donor. Despite this, transplant centers across the United States use different criteria in determining donor exclusion based on BMI. Based on a 2007 United States Transplant Center Survey, twenty percent of the transplant centers that were surveyed excluded those with BMI greater than 40 kg/m2, fifty two percent of United States kidney transplant centers excluded donors with BMI greater than 35 kg/m2, ten percent of programs excluded those with BMI over 30 kg/m2, twelve percent had no policy for exclusion, and six percent excluded based on BMI if they had other cardiovascular risks. ”

 

In short, only 60% of U.S. transplant centers follow or exceed OPTN policy.

40% of U.S. transplant centers accept higher at-risk living kidney donors than OPTN policy dictates.

 

There’s no point in having a policy if 40% of members won’t follow it. Especially if the governing organization will do nothing to enforce it. The whole thing is nothing more than theater, engineered to make the public *believe* transplant centers care about the health and well-being of kidney donors.

Unfortunately, it’s theater that’s already put over 30,000 people at risk.

 

 

*Overweight was defined as a BMI of 25 or higher.

Sachdeva, M. (2015). Weight trends in United States living kidney donors: Analysis of the UNOS database World Journal of Transplantation, 5 (3) DOI: 10.5500/wjt.v5.i3.137

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Follow-Up Liver Donor Living Donor Research Living Donor Risks Living Kidney Donor

American Society of Transplant Surgeons Winter Symposium 2015 Abstracts

Read ’em all here folks: http://onlinelibrary.wiley.com/doi/10.1111/ajt.13164/pdf

 

Long-Term Living Donor Outcomes: When To Say No Dorry Segev (Pg. 43).

“The risks of donation are real. And serious. And attributable to donating. In other words, there are things that might happen to an individual if he donates that would not happen to that individual had he not donated”

And

“And of course it will only get worse. No doubt as we follow the new cohort of donors with more medical issues (higher BMI, higher blood pressure, etc.) for much longer periods of time (current follow-up in large studies is relatively still “short-term” or “medium-term”), we will discover much more risk that donors take.”

 

Note: We/They aren’t following anyone. There is no living donor registry; we don’t even have one-year of comprehensive living donor data.

***

Non-Academic Transplant Business Intelligence – A Surgeon’s Perspective Robert Osorio (pg 47).

” transplant professional societies now host career development seminars to improve business intelligence among their membership. The paucity of literature is also improving, and reviews are now available regarding the finances of transplantation”

and

“In 2008, ASTS launched the first comprehensive compensation study for transplant surgeons practicing within the United States4 . These results have provided a better understanding of total compensation, including salary and benefits, of academic staff surgeons, program directors, and academic transplant surgeons in leadership positions. This type of study is readily used in compensation agreements requiring fair market value (FMV) estimates of salary for non-academic transplant surgeons who are in an employed model”

***

Eliminating the Significant Regional Variation in Donor Conversion Rates Provides the Most Significant Reduction To Waitlist Mortality. (pg 49)

” Redistricting might reduce waitlist mortality and potentially saves 563 lives over 5 years. Here we examine national donor conversion rates and waitlist opportunities.”

***

Hypertension and Diabetes in Live Kidney Donors and Matched Nondonors (pg 55).

“Living donors had lower diabetes than matched controls immediately after donation, but higher incidence past 10 years. Living donors had substantially higher long-term risk of diabetes. Risk of hypertension increased more quickly over time for black donors than nonblack donors. Hypertension incidence did not differ between donors and controls.”

***

Patterns of Physician Visits Before and After Living Kidney Donation (pg 66)

“Smokers, donors with less than college education, and male donors (particularly single men) are less likely to visit a PCP annually after-donation, and may benefit from targeted efforts to improve PCP followup.”

***

Predonation Characteristics Associated With Risk of End-Stage Renal Disease in Live Kidney Donors (pg 70)

“Obese donors and those with a high blood pressure have signifi – cantly higher 15-year risk of ESRD compared with other donors.”

**

Outcomes After Right Kidney Living Donor Transplant Are Associated With Center Volume (pg 76)

“RKLDT [Right Kidney Living Donor Transplant] is associated with a higher rate of GF [Graft Failure} among centers performing <12 RKLDT annually, whereas there is a 2-fold reduction in the RR of GF among experienced centers ( >12 RKLDT /year).”

**

Analytic Morphomics Do Not Predict Long-Term Outcomes in Living Kidney Donors (pg 83)

“Survey results were obtained from 598 living kidney donors (response rate 57.6%). The mean follow-up time from donation was 9.1 years. “

And

” however, 17.0% of patients reported new diagnosis of at least one significant cardiovascular risk factor including: diabetes(2.5%), hypertension(14.0%), kidney disease(1.0%), heart attack(0.3%), and stroke(1.3%).”

 

Categories
Living Donor Misinformation Living Donor Research Living Donor Risks Living Kidney Donor

How Not to Define Safety, Transplant Industry

The focus of this Egyptian transplant center study was the 8 living kidney donors who experienced kidney failure, as opposed to their overall 2000 LKDs. In the discussion section, however, the authors talked about *all* the donors, saying that 22% developed hypertension.

Let’s remember, hypertension is second to diabetes in causing kidney failure.

 

Then there’s this statement: “The authors found that the incidence of diabetes mellitus, hypertension, and cardiovascular morbidity among live-kidney donors were lower than those of age- and sex-matched Egyptian general population, and they confirmed the safety of live-kidney donation”.

Living kidney donors are supposed to be HEALTHIER than the general population. They *should* have lower rates of all of those things. The question is not how LKDs’ risk compares to the general population (which includes folks with high risk, who would never be approved to donate), but how it compares to their two-kidneyed risk. In other words, did donating a kidney increased that individual’s risk of those health issues? Overall, does donation increase that population’s* risk?

If the answer is yes, then living kidney donation is not ‘safe’.

 

*Population = living kidney donors.
Wafa EW, Refaie AF, Abbas TM, Fouda MA, Sheashaa HA, Mostafa A, Abo El Ghar MI, & Ghoneim MA (2011). End-stage renal disease among living-kidney donors: single-center experience. Experimental and clinical transplantation : official journal of the Middle East Society for Organ Transplantation, 9 (1), 14-9 PMID: 21605018

Categories
Living Donor Research Living Donor Risks Living Kidney Donor

Hyperfiltration: Adaptive or Maladaptive

Hyperfiltration is the term used to describe the changes in the remaining kidney after a nephrectomy (kidney removal).
 

As detailed here, it means that the vessels in the kidney widen under the increased pressure of filtering all the body’s blood, as well as a growth* in the actual cells that make up the glomeruli (small filter parts of the nephron). This increase’s the kidney’s re-absorption of sodium (salt) as well.

This process, or these changes, can be symptoms of diabetes or hypertension, or glomeruli damage. When it occurs in other parts of the body (eg. heart), it is seen as a significant health risk.

Yet the transplant industry has heralded the kidney’s adaptive capacity as more proof that living kidney donation is ‘safe’ for the donor, and does not leave him/her with any long-term ill renal effects.
 
 

The authors of this recently published study are not so sure. They conclude that “…alterations/adaptations in tubules and glomeruli in response to nephron deficiency may increase the risk of hypertension and renal disease in the long-term”.

Pass it on.

 
 
 
     
*Don’t confuse this with cell replication, which is how organisms normally grow. This is hypertrophy, an increase in cell size, not number.

For full abstract: http://onlinelibrary.wiley.com/doi/10.1111/nep.12198/abstract