Concurrent Oral Sessions

Abstract

Purpose: This study reports long term 25-years outcome of kidney donors in regular serial follow-up in a dedicated donor clinic and the impact of preventive intervention for post nephrectomy complication. Patient and Methods: Between 1986 and September 2012, 3748 kidney donors were follow-up in a dedicated donor clinic. Of these 3748 donors, data of 2696 (72%) is presented who were in regular serial follow. Protocol for follow-up was first visit between 6 months to 1 year and thereafter yearly. Follow-up included physical examination, laboratory investigation including 24 hours urinary creatinine clearance (CrCl) and protein excretion. The outcome of donors was compared with a control group of siblings who were selected as donors but could not donate due to technical or social reasons. Result: The mean age of 2969 donors was 34.3±9.8 years with a M:F ratio of 1.2:1. The mean pre donation CrCl was 109.8±22.3 ml/min/1.73m2. Post donation it fell to 77±17 at 1 year and showed a compensatory rise to 84 at 5 years and fell to 75 at 20 and 69 at 25 years. Mean protein excretion was 87 mg/24 hour pre donation and removed below 150 mg/ upto 5 years. In all 28 (1.0%) patient developed protein > 1000 mg/24. Overall 371 (14%) developed hypertension at a mean of 5 year follow-up and mean age of 43 years and diabetes in 95 (3.6%). Multivariate risk factor for GFR < 60 ml/min were pre donation age > 40 years, GFR < 80 ml/min and proteinuria > 300 mg pre donation protein excretion > 150 mg/ 24 hour, hypertension and smoking. In all 6 (0.2%) donors developed renal failure after 10-17 years of donation. Preventive intervention was undertaken for proteinuria in 380 donors where protein excretion remained below 300 mg, for hypertension in 347 donors where systolic and diastolic BP remained below 140 and 90 mm/Hg respectively for a total follow-up period of 14 years. Comparison of 90 donors with 90 sibling controls showed significantly high fasting glucose, hypertension, liver and cardiac disease in siblings. Mean GFR in donor was 84 ml/min vs 96 in sibling and protein excretion 99 vs 112 in sibling. Conclusion: Regular donor follow-up with investigation identifies risks and allows timely intervention to safeguard donor health and renal function. The outcome of donor is similar or better than siblings controls due to regular follow-up and care.