Advances in Understanding of Long-Term Living Kidney Donor Risks

Area of Science:

• Nephrology
• Transplantation Surgery
• Public Health

Background:

• Global demand for kidney replacement therapy necessitates expanding living kidney donation.
• Living kidney donation, in carefully selected individuals, has a low absolute risk of kidney failure (50 per 10,000 after 20 years).
• Incomplete data on lifetime risks, risk variations, and long-term safety for donors with chronic kidney disease (CKD) risk factors hinder transplantation rates.

Purpose of the Study:

• To review the evolution of risk assessment for living kidney donors.
• To highlight key determinants of post-donation kidney health, including post-donation CKD risk factors and acute kidney injury.
• To identify policy and practice changes for safely increasing living kidney donation.

Main Methods:

• Literature review examining changes in living donor risk assessment.
• Analysis of factors influencing long-term kidney health in living donors.
• Identification of policy and practice considerations for expanding living donation.

Main Results:

• Hyperfiltration injury is no longer considered a significant cause of kidney failure post-donation.
• Post-donation chronic kidney disease (CKD) risk factors and acute kidney injury are critical for assessing donor kidney health.
• The absolute risk of kidney failure for living donors is low, supporting expansion of donation.

Conclusions:

• Safely expanding living kidney donation requires addressing uncertainties in long-term donor risk.
• Prioritizing dedicated funding for post-donation care is essential for managing donor health.
• Improved data collection and management are crucial for informing current and future living kidney donors.