Is living kidney donation really safe?

Area of Science:

• Nephrology
• Transplant Surgery
• Urology

Background:

• Living donor kidney transplantation (LDKT) is a leading renal replacement therapy due to superior patient and graft survival rates.
• Increasing numbers of elderly patients on dialysis and limited cadaveric organ availability drive the reliance on LDKT.
• Concerns regarding donor safety necessitate an evaluation of long-term risks associated with living kidney donation.

Purpose of the Study:

• To assess the long-term health complications experienced by living kidney donors.
• To identify the incidence and types of post-donation complications in individuals who have undergone LDKT.

Main Methods:

• A cohort of 86 living kidney donors with procedures performed over one year prior were evaluated.
• Donors underwent regular follow-up for over three years, including physical exams, blood pressure monitoring, and laboratory tests (serum urea, creatinine, albumin, glucose, lipid profile, urinalysis, 24-hour urine protein).
• Renal and testicular ultrasounds were performed periodically to monitor for complications.

Main Results:

• The overall complication rate was 54.6%, with hypertension being the most frequent (37.5%).
• Serious complications occurred in 5.8% of donors. Other noted issues included elevated creatinine (>1.4 mg/dL) in 6.9%, microalbuminuria in 10.4%, hematuria in 13.9%, and renal stones in 6.9%.
• Psychological distress, including severe depression requiring antidepressants (9.3%), and persistent pain (44.1%) were also reported. Varicocele was found in 24.1% of males.

Conclusions:

• Living kidney donation is associated with notable long-term complications, challenging the perception of absolute safety.
• Hypertension, renal function changes, and psychological issues are significant risks for living kidney donors.
• Rigorous pre-donation assessment and comprehensive long-term follow-up are crucial for early detection and prevention of complications in living kidney donors.