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Follow-Up Living Donor Research Living Donor Risks

adrenal incidentalomas in potential kidney donors

You’re probably asking “What is an adrenal incidentaloma?” Well, I took the trouble of googling it for you, and in short, it means a lesion or mass bigger than a certain size hanging out on one’s adrenal gland. Usually, these AIs are found incidentally, during a medical scan of some sort that have nothing to do with the adrenal gland.

In other words, asymptomatic folks can have AIs.

 

The researchers decided to look for these little buggars in potential living kidney donors. Makes sense since they’re already exposing them to a battery of tests and scans anyway. Apparently 4.2% of their 673 subjects did have these suckers, and according to the paper, that’s a lot.

What I’m wondering, and what the authors don’t say, is: Which adrenal had the AI and which kidney was removed for donation? And secondarily, if the AI was on the left kidney, and the left kidney was removed, did the severing of the blood to the left adrenal (in combination with the AI) cause the LKD any post-donation adrenal malfunction? Or vice versa? In other words, did any of these “healthy, asymptomic” people develop adrenal issues post-donation?

Something tells me the researchers never considered those things as possibilities.

 

 

Grossman, A., Koren, R., Tirosh, A., Michowiz, R., Shohat, Z., Rahamimov, R., Mor, E., Shimon, I., & Robenshtok, E. (2015). Prevalence and clinical characteristics of adrenal incidentalomas in potential kidney donors Endocrine Research, 41 (2), 98-102 DOI: 10.3109/07435800.2015.1076455

Categories
Living Donor Research Living Donor Risks Living Kidney Donor Psychosocial Risks

1 in 10 Living Kidney Donors Report Negative Outcome

The RELIVE study is a poor substitute for comprehensive, mandatory living donor follow-up, but in the US where the healthcare system is capitalistic and money buys political influence, RELIVE is all we’ve got.

So, with a 36% response rate (dismal), the researchers found that 1 in 10 (10%) of living kidney donors report at least one negative outcome of donating, including: “fair or poor overall donor experience, financial burden, regret or discomfort with decision to donate, or psychological difficulties since donation”

“Rating the overall donor experience more negatively was associated with donor complications, psychological difficulties, recipient graft failure, and longer time since donation.”

I find that last bit most interesting.

  • Are the folks who’ve donated more recently still on the “high” from donating?
  • Are those same folks not ready to admit their experience wasn’t awesome? (Since the public perception is that LDs skip merrily off into the sunset, it can be difficult for LDs to admit anything to the contrary)
  • As folks get further away from their donation, are they experiencing more health and psychosocial issues?
  • We know transplants aren’t cures, so is it possible that the LDs further away from donating are more likely to have seen their recipients’ health decline or even die?

 

I have no conclusions, and neither does RELIVE, but the fact that LKD’s assessment of their living donor experience decline over time could be significant. It’s unfortunate we don’t have any long-term follow-up to know for sure.

 

 

Jacobs, C., Gross, C., Messersmith, E., Hong, B., Gillespie, B., Hill-Callahan, P., Taler, S., Jowsey, S., Beebe, T., Matas, A., Odim, J., Ibrahim, H., & , . (2015). Emotional and Financial Experiences of Kidney Donors over the Past 50 Years: The RELIVE Study Clinical Journal of the American Society of Nephrology, 10 (12), 2221-2231 DOI: 10.2215/CJN.07120714

Categories
Ethical Considerations Living Donor Research Living Kidney Donor Psychosocial Risks

Potential Kidney Donors Are Ambivalent

According to this Irish transplant center. 15.5% of potential LKDs voluntarily writhdrew from the evaluation process. However, the number is actually higher than they’re reporting. Apparently, In Ireland, if multiple potential LKDs come forward for a recipient and they are all acceptable blood and HLA matches, only *one* is permitted to continue with the evaluation (How they make the determination of which potential LKD proceeds is unclear). So, the authors are including *all* the potential LKDs who were adequate blood/tissue matches.

Their calculation is 95/614 (15.5%), whereas 261 of those 614 didn’t progress past the immunological test because of multiple potential LDs.

When those are removed, the statistic beomes 95/353, which is 26.9%.

 

Someone asked me why it was significant that over 1 in 4 potential living kidney donors deemed “acceptable” matches for a would-be recipient did not continue the evaluation progress.

First: coercion. It’s been well-established that potential living donors experience “pressure” to donate, and the closer (biologically/emotionally) one is to the prospective recipient, the greater that pressure, Ireland, unlike the US, is not as keen on random members of the living public donating their organs to strangers. Therefore, the potential LKDs in this study were emotionally and/or biologically related to their would-be recipient. That nearly 27% of them still decided not to be evaluated speaks volumes to the ambivalence present in many donor candidates.

This above fact is crucial because the public perception of living donation (which is carefully crafted by the transplant industry, specially selected living donors, and complicit media types) is that living donation is positively “life changing”* for the kidney donor. The knowledge that more than 1 out of 4 people who “match” their intended recipient choose not to donate can be comforting to other people who are suffocating under the pressure to continue with the process.

Living donation should be a *choice*, a fully informed and un-coerced choice, free from the pro-recipient foundation of the transplant system. Information like this helps to make that happen, and that’s invaluable.

 

*A rabbi is contacting living donors through social media to gather their quotes/words on how donating was “life-changing” for them. I’d like to link to the source material, but it was shared in a “closed” FB group and I have to respect the group’s rules.

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
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