Donors Do Well Long Term

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Donors Do Well Long Term

Rosemary Frei, MSc
August 25 2008

Lifespan, hypertension rate of kidney donors similar to general population

TORONTO—Long-term data show that kidney donors have a lifespan and hypertension rate comparable to the general population.

At the 2008 American Transplant Congress here, Hassan Ibrahim, MD, MS, associate professor of medicine in the division of renal diseases and hypertension, University of Minnesota Medical School, Minneapolis, presented data on 3,698 people who donated kidneys at the medical school between 1963 and 2007. The very low rates of end-stage renal disease (ESRD) and hypertension, high quality of life, and high rates of measured glomerular filtration rate (GFR) among these individuals are a testament to the safety of living kidney donation, he noted.

“The amount of information about the long-term risks and benefits of donating a kidney is limited,” Dr. Ibrahim said. “We are hoping that these data will help better delineate issues surrounding living kidney donation.”

Ron Shapiro, MD, professor of surgery at the University of Pittsburgh, agreed that the data underscore the long-term safety of donation.

“The important thing to realize is that the Minnesota experience is essentially unique in terms of its length of follow-up and percentage of donors captured in follow-up,” said Dr. Shapiro, who holds the Robert J. Corry Chair in Transplantation Surgery at the University of Pittsburgh's Thomas E. Starzl Transplantation Institute. “It is not perfect, but it is better than anything out there, except for the Scandinavian data—which demonstrate better long-term survival in donors than in the general population, but this is not a surprise, given the selection bias that only healthy people were allowed to donate. In terms of detailed follow-up, however, nothing compares to the Minnesota experience.”

The University of Minnesota data indicated that kidney donors—who had an average lifespan of 73.2 years—had similar life expectancies as members of the general population. ESRD developed in only 11 donors (0.3%). Furthermore, the average serum creatinine level was 1 mg/dL in people who had donated at least 30 years earlier. The estimated GFR had declined only gradually in the donors, reaching a level of approximately 40 mL/min/1.73 m2 after at least 30 years post-donation. The rates of hypertension were 32.7% among those who had donated 30-34 years earlier, and 36.2% among those who had donated at least 35 years before.

Albumin excretion rates and anti-hypertensive-use rates were relatively similar to the general population, while quality of life (QOL) was relatively high. QOL was measured using the Physical Component Scores and Mental Component Scores of the Short Form-12 or Short Form-36.

Didier Mandelbrot, MD, medical director of the Living Kidney Donor Program at Beth Israel Deaconess Medical Center in Boston, praised the study for confirming that there are few long-term medical complications associated with living kidney donation. “However, in interpreting the study and discussing the results with potential donors, it is important to recognize the study's limitations,” said Dr. Mandelbrot, who also is assistant professor of medicine at Harvard Medical School in Boston. “These include the fact that the donors from 40 years ago were all young and healthy. We cannot necessarily extrapolate from these donors to many of those donating today, who are often older, often have borderline hypertension, and may have borderline kidney function.”

http://www.renalandurologynews.com/Donors-Do-Well-Long-Term/article/115849