Long-term Risk of ESRD in Kidney Donors: Is There Really No Harm?
One of the most shocking presentations in the ATC was given during the last plenary session. Dr. Muzaale from John Hopkins presented their analysis of ESRD risk in living donors compared to a matched healthy control population.
So most of us quote several well-published studies suggesting that there is no increase in the risk of death or ESRD in kidney donors compared to the general population (see Ibrahim et al). The problem is the comparisons are to the general population – whom are not always that healthy. The difference between the presented study and prior studies is that the authors attempted to compare living donors to a healthy subset of the general population. They did this by using the NHANES III database and eliminating subjects that had conditions that could have excluded them from being a kidney donor. In fact, they excluded 53% of subjects and only included the remaining 47% as controls for the living donor cohort. Both living donors and controls were matched by age, sex, race, smoking history, systolic blood pressure, education and BMI. Some interesting characteristics of the donors include: 63.8% attended college, 24% were smokers, and 67% were related to the recipient. So here is the shocker – the risk of ESRD was 8 times the risk of ESRD in the healthy control group. Wow. ESRD incidence at 15 years was 0.31% in donors verses 0.04% for healthy matched controls. The highest risk was in elderly donors, black donors and male donors. They then looked at attributable risk and relative risk. When it came to race black donors had the highest risk of ESRD but the relative increase in risk was actually highest in white donors.
This is a very important study that I expect will be examined in extreme detail. Incidence of ESRD in kidney donors was low but still significantly higher than the authors’ control group. Methodology and results need to be closely reviewed as this study can have far reaching implications. Questions such as was the control group too healthy (as higher risk donors are now being accepted by more centers) need to be answered. For if there results are true, we may need to forever change the way we educate living donors.
Post written by Dr. Vinay Nair, eAJKD Advisory Board member.
Check out all of eAJKD’s coverage of the 2013 American Transplant Congress.