Health-Related Quality of Life After Living Kidney Donation: A Systematic Review and Meta-Analysis

Living donor kidney transplantation is considered the most effective treatment for end-stage kidney disease, but healthy individuals who donate may experience potential threats to their long-term well-being. This meta-analysis assessed the impact of living kidney donation on health-related quality of life (HRQoL) among donors overall and among those at higher risk for negative health impacts.

Systematic review and meta-analysis.

Living donors of kidney allografts included in studies of postdonation HRQoL with predefined inclusion and exclusion criteria. Studies were identified through a comprehensive search of Embase, MEDLINE OvidSP, CENTRAL, Web of Science, PsycINFO, and the top 100 rankings in Google Scholar.

Data were extracted in accordance with PRISMA guidelines, with independent extraction by multiple observers to ensure accuracy.

Primary outcomes included the 36-item Short-Form Health Survey (SF-36) and its composite mental component summary (MCS) and physical component summary (PCS). These measures were used to compare postdonation HRQoL with predonation levels and to the HRQoL of the general population. Study-level effects were calculated as standardized mean differences for continuous variables. Pooled effects were estimated with a random-effects model using restricted maximum likelihood.

The meta-analysis included 73 studies with 14,474 donors. The MCS did not show significant changes at 3, 6, or 12 or more months after donation compared with baseline. However, the PCS was significantly lower at 3 months after donation compared with before donation (standardized mean difference, -0.38 [95% CI, -0.72 to -0.05], P = 0.02), which did not persist at 6 or 12 months. Both PCS and MCS scores were significantly higher in donors than in the general population. Donors' HRQoL scores were comparable to or better than those of healthy controls, recipients, patients who underwent a nephrectomy, and patients receiving maintenance dialysis.

Heterogeneity in study populations and outcomes, a limited number of studies for certain comparisons, methodological weaknesses of especially older studies, variability across geographies studied, and unaccounted for temporal changes.

Kidney donors reported physical HRQoL to be decreased after living donor nephrectomy, which returned to predonation levels by 6 months. The HRQoL reported by living donors was significantly better than that of the general population and healthy controls. These findings suggest that concerns about postdonation HRQoL need not be a deterrent to potential living kidney donors.

Registered at PROSPERO with study number CRD42024540202.

This study examined the well-being of living kidney donors after donation by summarizing the findings of 73 studies, which included more than 14,000 donors. Overall, the donors' quality of life remained high. Their physical health was slightly lower 3 months after donation but returned to predonation levels shortly afterward. Their quality of life related to mental health remained unchanged after donation. Donors generally experienced health comparable to or better than that of the general population and other patient groups. Certain factors, such as complications or stress related to the recipient's condition, may temporarily have affected donors' well-being, but most recovered fully within a year. These findings may reassure potential donors that kidney donation does not typically have long-term negative effects on their health.