What are the short and long term outcomes for living kidney donors including surgical risk?
A major concern for living donors is the long-term impact of having a solitary kidney, with risk for developing hypertension, proteinuria, and chronic kidney disease. Most of the available data suggests that the risks of living donor donation is low enough to justify such donation. However, this data is limited by several factors including short observation times, lack of racial diversity, insufficient power, and donors lost to follow-up. The operative risk is very low, with studies showing a 90-day mortality rate of 0.03%. Blood transfusions, vascular complications, and returning to the operating room occurred in <0.5% of cases. The most common complication seen in the immediate postoperative time period is gastrointestinal—specifically, increased reflux, bowel injury, and abdominal hernias.
The most important risk factor for long-term poor donor outcomes, including the development of diabetes, hypertension, and worsening kidney function, is the development of obesity post-donation. Long-term risks include cardiovascular and kidney complications. Most studies have shown that kidney donation does not portend a greater cardiovascular risk. The average loss of kidney function after donation is about 30%. The risk of hypertension is elevated in donors compared to non-donors by as much as 5% to 20%. Donors who are black, obese, or have high blood pressure are most at risk for progressive CKD after donating a kidney.
End-stage kidney disease (ESKD) risk in living kidney donors is less than the general population. Donors should be informed that, while there is an increased relative risk of ESKD after kidney donation, the absolute lifetime risk for ESKD in a donor is 0.9% as compared to the 3.2% lifetime risk for the general population.