Risks of Living Donor Nephrectomy

Abstract

Introduction There is good evidence that long-term graft survival is superior when living donors are used for kidney transplantation. Nevertheless, an assessment of potential risks associated with living donation is of particular interest. Patients and Methods In this single-center study, we evaluated the renal function of 31 kidney living donors (1997–2003) at 2–13.2 years after nephrectomy. The purpose of this study was to evaluate perioperative complications, renal function, new-onset proteinuria, and hypertension. Results Living related donation was performed in all cases. The average time after donation was 5.7 ± 2.4 years. The mean age at nephrectomy was 46.3 ± 9.0 years (range, 25–64), and 26 (83.9%) donors were females. Twelve patients (29%) were older than 50 years. The left kidney was used in 25 patients (80.6%). Surgical complications occurred in 2 patients. Glomerular filtration rate (GFR) decreased from 116.9 ± 23 to 77.7 ± 19.2 mL/min/1.73 m 2 ( P < .001). Five patients (16.1%) developed a postdonation GFR between 50 and 60 mL/min/1.73 m 2. Patients with lower GFR values after uninephrectomy showed lower predonation values ( P < .05). Older patients (>50 years) displayed lower postdonation GFR than younger ones. We did not observe an increased prevalence of low postdonation GFR over time nor significant differences in protein excretion and blood pressure. Conclusions Living donor nephrectomy appears to be an acceptably safe intervention. Despite a reduction in GFR, the postdonation incidence of hypertension was low and proteinuria was not observed in any donor, even among previously hypertensive patients. Rigorous donor follow-up is recommended to identify persons at risk.