From the Chair: Predicting the Risk of Kidney Failure among Kidney Donors

One can only donate if this act doesn’t put one’s own health and identity in serious danger.1

While kidney donation markedly improves the lives of recipients, recent studies have shown that the long-term risk of end- stage renal disease (ESRD) among donors is about 11 times greater than that in matched healthy nondonors2. That said, the absolute 15-year risk of ESRD is <0.5%2. Thus, while explaining that donation is associated with increased risk compared with not donating, the actual risk for an individual is actually quite low.

Still, understanding and predicting an individual’s risk associated with kidney donation with some precision continues to be elusive. Many centers base their decision-making reagrding the acceptance of a candidate as a donor on individual risk factors such as body mass index or the presence of hypertension.

Recent work by Allan Massie and colleagues3 in the September 2017 issue of the Journal of the American Society of Nephrology sheds light on this issue. Massie et al. advocate for a comprehensive estimate of patient-specific risk of ESRD using multiple factors (integrated into an online calculator).

Massie and colleagues studied 133,824 living kidney donors from 1987 to 2015 using standard analytical methods. They report that black race was associated with a nearly 3-fold and male gender with a nearly 2-fold higher risk of ESRD in donors (hazard ratio [HR], 2.96 and 1.88 respectively). Among nonblack donors, older age was associated with a modestly greater risk (HR per 10 years, 1.40), whereas among black donors, older age was not significantly associated with a greater risk of ESRD.

The study concludes: “Living kidney donors voluntarily undergo surgery for no direct medical benefit to themselves; it is therefore incumbent upon the transplant community to provide donors with accurate estimates of long-term risk to improve shared decision-making and to provide clinical decision support in the donor evaluation process.”

The bottom line is that Massie’s study is likely to change how we evaluate kidney donors.

While the absolute risk of ESRD is low for kidney donors, the Massie study shows that young black men are at relatively higher risk of ESRD than other donors. Therefore, this population should be carefully scrutinized, and, equally important, provided information on the long-term risk of ESRD to ensure that informed consent can occur.

 

References

  1. Benedict XVI on Organ Donation “A Unique Testimony of Charity” Nov 7, 2008. https://zenit.org/articles/benedict-xvi-on-organ-donation/ Accessed Oct 30, 2017.
  2. Lam NN, Lentine KL, Levey AS, Kasiske BL, Garg AX. Long-term medical risks to the living kidney donor. Nat Rev Nephrol. 2015 Jul;11(7):411-9.
  3. Massie AB, Muzaale AD, Luo X, et al. Quantifying Postdonation Risk of ESRD in Living Kidney Donors. J Am Soc Nephrol. 2017 Sep;28(9):2749-2755.