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  • Review Article
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Long-term medical risks to the living kidney donor

Nature Reviews Nephrology volume 11, pages 411–419 (2015)Cite this article

Subjects

Key Points

  • Transplantation of kidneys from living donors is an important treatment for kidney failure, but the long-term risks to kidney donors are unclear; understanding the risks could improve the informed consent process

  • Studies suggest that living kidney donors are at increased risk of developing end-stage renal disease relative to healthy nondonors, but the 15-year cumulative incidence remains <1%

  • All-cause mortality in the first decade after nephrectomy seems to be lower or no different among donors than among healthy nondonors; one study suggests that over 25 years, the incidence might increase by 5%

  • The absolute incidence of gout might increase by <2% in the first decade after donation among donors compared with healthy matched nondonors

  • Women should be informed that complications of pregnancy are more likely after donation than before donation and that their risk of gestational hypertension and pre-eclampsia is 6% higher than that in nondonors

  • Risks of acute kidney injury, cardiovascular events, kidney stones requiring surgical intervention, major gastrointestinal bleeding and skeletal fractures do not seem to be increased in the decade after kidney donation

Abstract

Living kidney donation benefits recipients and society but carries short-term and long-term risks for the donor. This Review summarizes the studies that underlie our current understanding of these risks in the first decade after donation, with a view to improving the informed consent process. Two studies report a higher risk of end-stage renal disease (ESRD) among donors than among healthy nondonors; however, the absolute 15-year incidence of ESRD is <1%. All-cause mortality and the risk of cardiovascular events are similar among donors and healthy nondonors, although one study provides evidence for a 5% increase in all-cause mortality after 25 years that is attributable to donation. Some evidence suggests that the 20-year incidence of gout is slightly higher among donors than among healthy nondonors. The risks of gestational hypertension or pre-eclampsia seem to be 6% higher in pregnancies among donors than in pregnancies among healthy nondonors. The incidences of acute kidney injury, kidney stones that require surgical intervention, gastrointestinal bleeding and fractures seem no higher among donors than among healthy nondonors, although some of these conclusions are based on a small number of events. Future studies must clarify the lifetime incidence of long-term outcomes, particularly in relation to a donor's age, race, and history of comorbidities.

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Acknowledgements

N.N.L. is supported by the Clinical Investigator Program at Western University and by a Kidney Research Scientist Core Education and National Training Program postdoctoral fellowship award. K.L.L. is supported by a grant from the NIH National Institute of Diabetes and Digestive and Kidney Diseases, entitled “Long-term health outcomes after live kidney donation in African Americans” (R01-DK096008). B.L.K. is supported by a grant from the NIH National Institute of Diabetes and Digestive and Kidney Diseases, entitled “Assessing long-term outcomes of living donation” (U01-DK066013-09). A.X.G. is supported by the Dr Adam Linton Chair in Kidney Health Analytics.

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Authors and Affiliations

  1. Department of Medicine, Division of Nephrology, Western University, London Health Sciences Centre, 800 Commissioners Road East, London, ON N6A 4G5, Canada

    Ngan N. Lam & Amit X. Garg

  2. Department of Internal Medicine, Division of Nephrology, Saint Louis University, 3635 Vista at Grand Boulevard, St. Louis, 63110, MO, USA

    Krista L. Lentine

  3. Division of Nephrology, Tufts Medical Center, 800 Washington Street, Boston, 02111, MA, USA

    Andrew S. Levey

  4. Department of Medicine, Hennepin County Medical Center, 701 Park Avenue, Minneapolis, 55414, MN, USA

    Bertram L. Kasiske

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N.N.L. and A.X.G. researched data for the article. N.N.L., K.L.L. and A.X.G. wrote the article. All authors contributed to discussion of the content and reviewed and/or edited the manuscript before submission.

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A.X.G. has received an investigator-initiated grant from Astellas Pharma and Roche to support a Canadian Institutes of Health Research study in living kidney donors, and his institution received unrestricted research funding from Pfizer. The other authors declare no competing interests.

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Lam, N., Lentine, K., Levey, A. et al. Long-term medical risks to the living kidney donor. Nat Rev Nephrol 11, 411–419 (2015). https://doi.org/10.1038/nrneph.2015.58

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