Guest blog: Risks for donors associated with living kidney donation: meta-analysis

Living kidney donation (LKD) offers the best treatment for people suffering from end stage renal disease (ESRD)1.

Worldwide, the majority of transplanted kidneys come from deceased donors. This generous act is commendable, especially because it often arises from a very difficult situation for the patient’s family, for example after sudden death. However, living donation is considered truly altrustic, i.e. giving for another’s benefit. Research shows that LKD offers numerous advantages to the recipient, namely pre-emptive transplantation, with the possibility to plan the surgery in advance and less immunological and ischaemic insults, since the retrieved organ often comes from the same hospital and/or a well-matched donor. LKD is the ideal option for patients with complicated histories, such as repeated kidney transplant recipients2.

It is paramount to preserve a living donor’s health, remembering the Hippocratic principle of “First do not harm”. In the present systematic review3, we meta-analysed the risks, stratifying outcomes of interest in relation to donor demographic characteristics, to offer a valuable tool for health care staff involved with prospective donor candidates and managing their long-term follow up. Our approach aimed to shed a light on the evidence, in the context of Diversity and Inclusion, assessing each candidate on the basis of his/her personal demographic characteristics. These included ethnicity, body mass index (BMI), age, and sex. We looked at kidney function, expressed as estimated glomerular filtration rate (eGFR) adjusted for body surface area, incidence of ESRD, serum creatinine level at one year, donor survival, incidence of proteinuria, de novo hypertension, and surgical complications.

Unfortunately there is still long way to go to achieve true equity in healthcare. Most of the current eGFRs formulas are biased, resulting from diagnostic and treatment algorithms predominantly based on male Caucasian individuals. This implies the lack of focus research, potentially undertreating a particular condition, like ESRD in women and ethnic minorities.

Our study did not show significant difference in donor kidney function, assessed by eGFR, at one-year post donation between Africans and Caucasians. However, in the long term, African donors were more likely to develop ESRD than Caucasians.

Male donors were found to have a higher risk of developing ESRD, in accordance with reports highlighting a more severe course of kidney failure in men. Furthermore, donor mortality was found to be slightly higher in males, both in the short and long term.

Donor obesity was associated with a lower eGFR at one year, a mean of 2.70 (95 per cent c.i. −3.24 to −2.15) ml per min per 1.73 m2 lower than that of non-obese patients. BMI did not have an impact on intra- and postoperative complications.

Donors aged > 60 years had lower eGFR and higher serum creatinine; yet, this finding was not observed with a 50 year cut-off: in fact, at one year follow up, there was no significant difference, so kidney function of younger donors might have deteriorated.

Although we showed relative risk difference, a healthy person can live a completely normal life with only one kidney; indeed, some people are born in this way. Thus if a kidney is donated, the remaining increases slightly in size and capacity, and can carry on the required functions. LKD is only carried out in specialised centres, and donors undergo a full screening before proceeding and are routinely followed up. Therefore, in general, they remain healthy individuals who undergo a low-risk procedure4, but who provide a maximal benefit expanding the limited organ donor pool and setting the scene for the best outcome in the recipient.