Categories
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

Categories
Informed Consent Living Donor Research

Left Kidney Donation Preference

During living kidney donation, the left kidney is most often taken because the right kidney rests behind the liver. In simple terms, it’s easier to access the left kidney. But it also appears that the left kidney has a longer renal vessel than the right (an important consideration that is rarely, if ever, mentioned during living donor evaluation or informed consent).

The authors examined the outcomes of right vs left kidney transplants and found:

Transplants from deceased donors resulted in no discernible differences, BUT

Right kidney grafts from living donors had a much higher rate of “technical failure” than left kidney grafts.

 

Specifically:

“Technical failure was…defined as graft failure within 10 days without signs of acute rejection.”

 

If your surgeon suggests taking the right kidney over the left, do not be afraid to have this discussion.

 
Özdemir-van Brunschot, D., van Laarhoven, C., van der Jagt, M., Hoitsma, A., & Warlé, M. (2015). Is the Reluctance for the Implantation of Right Donor Kidneys Justified? World Journal of Surgery, 40 (2), 471-478 DOI: 10.1007/s00268-015-3232-0

Categories
Living Donor Research Living Donor Risks Living Kidney Donor

Kidney Donors Suffer More Pain

The authors compared 30 living kidney donors with 30 other individuals who underwent a nephrectomy (kidney removal) because of a tumor.

They found that living kidney donors experienced more pain than the comparison group, and they asked for (and were given) more pain medications.
Wang, J., Fu, Y., Yuan, T., & Wang, N. (2015). Comparison of Postoperative Analgesic Requirements in Living Donors and Patients Undergoing Similar Surgical Procedures Transplantation Proceedings, 47 (6), 1896-1900 DOI: 10.1016/j.transproceed.2015.04.088

Categories
Liver Donor Living Donor Research Psychosocial Risks

Psychiatric Complications in Living Liver Donors

The authors studied 142 donors who underwent live-donor liver transplantation at Nagoya University Hospital between April 2004 and July 2014. None of the living donors had pre-existing psychological complaints prior to donation.

 

4.2% developed psychiatric complaints after donation, including major depressive disorder, panic disorder, conversion disorder, and substance use disorder.

(my emphasis)

“all donors received anti-anxiety drugs, half took anti-depressants, and supportive psychiatric therapy was concomitantly provided to all subjects. The average treatment period was 53.3 months. Regarding subject outcomes, 50% donors achieved remission, and the other half continued treatment.”

 

The average treatment period was 4.5 years. Think of that whenever someone says that liver donation has no long-term consequences.

 
Kimura, H., Onishi, Y., Sunada, S., Kishi, S., Suzuki, N., Tsuboi, C., Yamaguchi, N., Imai, H., Kamei, H., Fujisiro, H., Okada, T., Ishigami, M., Ogura, Y., Kiuchi, T., & Ozaki, N. (2015). Postoperative Psychiatric Complications in Living Liver Donors Transplantation Proceedings, 47 (6), 1860-1865 DOI: 10.1016/j.transproceed.2015.06.021

Categories
Liver Donor Living Donor Research Living Donor Risks

Liver Regeneration in Living Donors

The authors examined the liver function and liver volume of 91 right liver lobe donors.

Within a year of donating, 96% had regained full liver function but only 85% had full pre-donation liver volume.

 

Unfortunately, these results say nothing about the long term risk of scarring (cirrhosis) or otherwise.

 
Duclos J, Bhangui P, Salloum C, Andreani P, Saliba F, Ichai P, Elmaleh A, Castaing D, & Azoulay D (2016). Ad Integrum Functional and Volumetric Recovery in Right Lobe Living Donors: Is It Really Complete 1 Year After Donor Hepatectomy? American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons, 16 (1), 143-56 PMID: 26280997