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Evaluating Risk in Kidney Living Donors
Fernanda Ortiz1, Lorna Marson2, Rachel Thomas2
1Abdominal Unit, Nephrology, Helsinki University Hospital, Helsinki, Finland.
Abstract:
Kidney donation is a safe procedure for carefully screened donors. The growing shortage of organs and improved survival rates among recipients of living donor transplants have broadened the criteria for acceptable living donors, including older individuals and those with pre-existing health conditions. Consequently, ensuring both the short- and long-term safety of living donors is of paramount importance. The primary objectives are to prevent the need for kidney replacement therapy, major cardiovascular events, or premature death. Lifelong monitoring of living donors is essential to facilitate early treatment for preventable illnesses. To this end, annual follow-up is generally recommended, which should minimally include an assessment of blood pressure, body mass index, kidney function, albuminuria, lifestyle factors, and general wellbeing. However, the management of these risk factors and treatment targets in this population remain inadequately defined. Recommendations for genetic counseling in cases of living-related donation also remain inconsistent. The aim of this mini-review is to address the challenges in evaluating the evidence on the long-term consequences of kidney donation, particularly concerning the risk of developing end-stage kidney disease, cardiovascular mortality, gestational complications, and hypertension. This article aligns with the ESOT call for action to promote living kidney donation and EKITA's mission.
Insights
Living kidney donation is safe, but long-term donor health requires better-defined monitoring. Annual check-ups are recommended to prevent kidney disease and cardiovascular events in living donors.
Area of Science:
- Nephrology
- Transplant Surgery
- Public Health
Background:
- Living kidney donation is crucial due to organ shortages and improved transplant outcomes.
- Expanded donor criteria include older individuals and those with pre-existing conditions, increasing the need for safety monitoring.
- Ensuring donor safety, both short- and long-term, is paramount to prevent kidney replacement therapy, cardiovascular events, and premature death.
Purpose of the Study:
- To review the challenges in evaluating long-term consequences for living kidney donors.
- To address risks such as end-stage kidney disease, cardiovascular mortality, gestational complications, and hypertension.
- To align with calls for action promoting living kidney donation.
Main Methods:
- Mini-review of existing literature on long-term outcomes of kidney donation.
- Analysis of evidence regarding risks to living donors.
- Discussion of current monitoring recommendations and their limitations.
Main Results:
- Lifelong monitoring of living donors is essential for early detection of preventable illnesses.
- Annual follow-up should assess blood pressure, BMI, kidney function, albuminuria, lifestyle, and well-being.
- Management targets and genetic counseling recommendations for living donors are not well-defined.
Conclusions:
- Further research is needed to establish clear guidelines for managing risk factors in living kidney donors.
- Optimizing lifelong monitoring protocols is critical for the sustained health of living kidney donors.
- This review highlights areas for improvement in supporting living kidney donors throughout their lives.
