Post living kidney donation risk in relation to the donor baseline demographic characteristics: a systematic review and meta-analysis

Journal article

Introduction: Living kidney donation risk is likely to differ according to donor’s demographic characteristics.

Methods: Systematic review and meta-analysis of the effects of age, sex, body mass index (BMI) and ethnicity on donor’s kidney function, end stage renal disease (ESRD) incidence, survival, proteinuria, hypertension, and surgical complications.

Results: 5129 studies were identified, 31 meeting the inclusion criteria, mainly from USA and Europe. Donors aged > 60 years had on average 9.54 ml/min/1.73m2 lower eGFR compared to younger donors(p<0.001). Female donors demonstrated higher relative short and long-term survival, and BMI>30 was found to significantly lower donor’s eGFR 1-year post-donation: on average the eGFR of obese donors was 2.7 ml/min/1.7m2 lower (95%CI: -3.24 to -2.15 p<0.00001) compared to non-obese patients. Obesity was also associated with higher blood pressure both pre- and 1-year post-donation and higher proteinuria, but it had no impact on operative complications. Lastly, no significant difference was found in one-year donor kidney function in association to ethnicity; however, in the long-term, African donors were more likely to develop ESRD compared to Caucasians, although it is likely that kidney donation does not increase the overall risk of ESRD, as the rates of ESRD within each racial group were comparable to their counterparts in the general population.

Conclusion: Obesity and male sex were associated with inferior outcomes. Post-donation, donors aged>60 increased their eGFR gap, compared to younger donors. African donors had a higher incidence of ESRD compared to Caucasian donors. BMI lowers eGFR post-donation, although the clinical significance is minimal.

Authors: Bellini, MI; Nozdrin, M; Pengel, L; Knight, S; Papalois, V

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: Oxford University Press
• Journal: British Journal of Surgery
• Volume: 109
• Issue: 8
• Pages: 671–678
• Publication date: 2022-05-25
• Acceptance date: 2022-03-21
• DOI: 10.1093/bjs/znac114
• EISSN: 1365-2168
• ISSN: 0007-1323
• Language: English
• Keywords: FFR