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The living, related kidney donor: a follow-up study
B Liounis1, L P Roy, J F Thompson
1Department of Nephrology, Royal Alexandra Hospital for Children, Camperdown, NSW.
Insights
Living-donor kidney transplants in children offer a high graft survival rate. Donors experience minimal risks and complications, with most willing to donate again.
Area of Science:
- Nephrology
- Pediatric Surgery
- Transplantation Immunology
Background:
- Living-donor kidney transplantation is a vital treatment for pediatric end-stage renal disease.
- Parental donation is most common, but sibling and emotionally related donations also occur.
Purpose of the Study:
- To evaluate the outcomes and complications of living-donor kidney transplantation in children.
- To assess the long-term safety and donor satisfaction following nephrectomy.
Main Methods:
- Retrospective analysis of 41 living-donor kidney transplants over 11 years.
- Monitoring of graft function, perioperative complications, and long-term donor health (blood pressure, renal function).
Main Results:
- 73% graft survival at follow-up.
- Most common perioperative complications were transient respiratory issues.
- Long-term donor complications included incisional pain (20%) and depression (25%), with no impact on transplant success.
- Minor changes in donor renal function and blood pressure were observed, comparable to community prevalence.
- All donors expressed willingness to donate again.
Conclusions:
- Living-donor kidney transplantation is a safe and effective procedure for children, with high graft survival.
- Donor risks are low, with minimal long-term sequelae and high donor satisfaction.
- This procedure significantly improves the quality of life for pediatric recipients.
Abstract:
Thirty-eight children received 41 living-donor kidney transplants in an 11-year period; 73% of the grafts are functioning well. The parents of the recipients were the usual donors (60% of the donors were mothers and 25% of the donors were fathers); however, there were five donations from siblings and one donation from a donor who was related emotionally to the recipient. The most frequent perioperative complications were respiratory but these were not serious and did not cause any long-term sequelae. The principal long-term complications that related to--or were perceived by the donor as being related to--the procedure were incisional pain (20% of donors) and depression (25% of donors). These were not related to the success or otherwise of the transplantation. At follow-up, five (12%) donors had diastolic blood pressure levels of greater than 90 mmHg or were receiving antihypertensive therapy; this prevalence is similar to that which is found in the community. Two donors had urinary protein excretion rates of greater than 200 mg/24 h (210 mg/24 h and 350 mg/24 h, respectively). Creatinine clearance rates fell by 15% in women and by 5% in men. Serum creatinine levels had risen by 40% in men and by 35% in women after the nephrectomy; these levels had changed little at follow-up. All donors said that they would have proceeded with the donation even with fore-knowledge of what they would experience during and after the donation. Living-donor renal transplantation is a procedure with very low but definite operative risks which nevertheless provides a means for the early effective replacement of renal function in children with growth potential. The donors are enabled to make a major contribution to the life and well-being of the child, and they regard the perioperative complications as minimal. There do not appear to be any serious long-term complications of renal donation.