Health-Related Quality of Life in Living Kidney Donors Participating in Kidney Exchange Programs

Abstract

Abstract Kidney exchange programs (KEP) have revolutionized living donor kidney transplantation (LDKT) by enabling transplants for patients with HLA or ABO incompatible donors. However, the implications for donors participating in KEP, particularly regarding postoperative health-related quality of life (HRQoL), are not well elucidated. This study compares the HRQoL of donors participating in KEP with donors donating directly (non-KEP). The study included 724 donors, with 121 in the KEP group and 603 in the non-KEP group. Outcomes were assessed using the mental component summary (MCS), physical component summary (PCS), EQ-5D-3L, MVI-20 score, and self-rated pain level. We used a mixed-effects regression model to assess differences between KEP and non-KEP over time, accounting for repeated measures within subjects. There was a significant temporary decline in both the MCS and PCS post-donation; however, these outcomes returned to pre-donation levels after an interval of two month. Donors participating in the KEP had higher PCS and MCS 1-year post-donation. Comparable results were observed in the self-assessed HRQoL using the EQ-5D-3L instrument, as well as in the fatigue scores measured by the MVI-20. We found that participation in KEP does not adversely affect donors' short- or long-term mental and physical HRQoL outcomes and that LDKT donors have HRQoL of pre-donation levels soon after donation. These insights are reassuring, indicating that donors participating in KEP can expect HRQoL comparable to those who do not. This reinforces the viability of KEP as a safe option for expanding LDKT and findings can inform patient and donor education.