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Cleveland Clinic researchers study health of living kidney donors following surgery; results are reassuring, they say
Angela Townsend, The Plain Dealer By Angela Townsend, The Plain Dealer
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on September 26, 2013 at 5:00 PM, updated September 26, 2013 at 6:39 PM
CLEVELAND, Ohio -- Health complications experienced by living kidney donors have declined, as has the time they spend in the hospital following surgery, according to a study that will appear in the Clinical Journal of the American Society of Nephrology.
Researchers from the Cleveland Clinic and Beth Israel Deaconess Medical Center in Boston conducted the study, which involved analyzing health data from more than 69,000 living donors from 1998 to 2010 (representing 89 percent of such donors in the United States during that time).
While the data showed that patients experienced fewer medical complications over time, it also revealed that other health issues affecting donors -- depression, hypothyroidism, hypertension, and obesity -- have increased slightly.
More than one-third of kidney transplants in the U.S. involve organs coming from living donors.
“Unfortunately, there are only limited studies [that focus on] the health of living donors long-term and even short-term,” Jesse Schold, assistant staff at the Clinic’s Lerner Research Institute, and lead study author, told The Plain Dealer. “Part of that is because our traditional national registries have a hard time capturing that data over an extended period of time.”
One of the motivations for pursuing the research, Schold said, was to try to fill in some of that information gap, and to underscore the importance of long-term patient follow-up by hospital transplant teams.
To evaluate trends in the illnesses and complications experienced by donors, the researchers studied the health of more than 69,000 donors. They used data from the Nationwide Inpatient Sample, a public database that each year compiles information from roughly 8 million hospital stays; and the Scientific Registry of Transplant Recipients.
The average age of the donors was about 40 years old. More than two-thirds were Caucasian, with 59 percent of donors female.
Among the major findings:
• Complications declined over time, from 10.1 percent in 1998 to 7.6 percent in 2010.
• Hospital length-of-stay following donation declined over time, from an average of 3.7 days in 1998 to 2.5 days in 2010.
• The rates of complications and length-of-stay for donors were comparable with other relatively low-risk abdominal surgeries that required the removal of an organ, such as appendectomies.
• Depression, hypothyroidism, hypertension, and obesity increased slightly over time.
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The “fairly reassuring” findings back up anecdotal evidence and data collected from studies conducted at individual transplant centers, Schold said.
The increase in depression, hypertension (high blood pressure) and other conditions might be interpreted in two ways, he said.
“We might be doing a better job of capturing and documenting those risk factors, [or] there may be an increased prevalence,” he said, adding that either way, it provides critical information for researchers so they know to monitor those health issues closely.
For the next year, the transplant team at the Cleveland Clinic will keep tabs on the health of Octavian Maianu of Macedonia. On Aug. 20 he donated a kidney to his close friend Ryan Crecco, who 16 months before found out he was suffering from kidney failure.
Maianu, who has had his one-month follow-up, said his recovery has been going well, apart from a little pain and discomfort.
“The first week was rough,” said Maianu, 35, an academic advisor at Kent State University’s Geauga Campus. Home from the hospital three days after surgery, he is slowly regaining his strength.
Before Crecco’s diagnosis, Maianu said he never thought about kidney disease or kidney transplant, much less becoming a donor. Of the countless friends who stepped up for the initial evaluation, Maianu and his wife, Jennifer, were the most promising matches; he turned out to be the best candidate.
Maianu is one of more than 1,500 living kidney donors to undergo surgery since the Clinic's kidney transplant program began in 1963. The Clinic has performed more than 4,200 kidney transplants in that time.
Even though physicians have told Maianu that he will have to get his remaining kidney evaluated once a year for the rest of his life, neither that nor any risk of hypertension or any other potential health issues in the future are weighing on his mind.
“Honestly, I feel like I never had surgery,” he said earlier this week. “My quality of life hasn’t changed at all.”
It’s a responsibility of the transplant community to continue paying attention to and evaluate the health of living kidney donors long after the initial surgery, Schold said.
“We already know from multiple studies that it provides a significant survival benefit to the recipient,” he said. But for the donors, “We can’t just assume over time that we’re going to continue to see that these risks are low.”
http://www.cleveland.com/healthfit/index.ssf/2013/09/cleveland_clinic_researchers_s_1.html