Is living kidney donation really safe?

Living donor kidney transplantation (LDKT) yields the best results of all renal replacement therapies in terms of patient and graft survival. It is the main method in many countries because of worsening patient outcomes due to the accumulation of aged patients with long periods on dialysis and no possibility to increase the number of cadaver donor transplantations. Because of concerns dealing the risks inflicted on the donors, we sought to evaluate the long-term complications of LDKT.

We evaluated over 3 years 86 living kidney donors (58 men, 28 women) whose procedures were >1 year ago. The mean time postoperatively was 17.24 +/- 5.04 months and their mean age, 28.97 +/- 4.75 years. Basic information regarding current health status, including physical examination and blood pressure as well as serum urea, creatinine serum albumin, blood glucose, lipid profile, urinanalysis, and 24-hour urine protein were evaluated every 6 months after donation. Also an ultrasound of the kidney, urinary tract, and testis was performed at these times.

Donor nephrectomies were left sided in 60 (69.8%) cases and right sided in 26 (30.2%) cases. The majority of the donors (n=80) were unrelated (93%). There was a total complication rate of 54.6%. The most common complication was hypertension (37.5%). Serious complications occurred in five cases (5.8%). In six (6.9%) the patients serum creatinine was >or=1.4 mg/dL. Microalbuminuria was found in 10.4%; hematuria in 13.9%; pyuria in 8.1%; and renal stone in 6.9%. Varicocele was found in 24.1% of male patients (23.3% of patients who had left nephrectomised). Persistent pain was reported by 44.1%. Antidepressants were prescribed to 9.3% of donors because of severe depression.

Living kidney donation is not so safe and has some late complications. Precise predonation evaluation and long-term follow-up of kidney donors for detection and prevention of complications is necessary.