1932

Abstract

Living-donor kidney transplantation is the preferred treatment for kidney failure. In the United States, rates of living kidney donation have been stagnant, which is partly related to concerns over medical and financial risks. Recent research has better characterized the risks of living kidney donation, although the field is limited by a lack of robust registries. Available evidence supports small increases in the risks of end-stage kidney disease and hypertensive disorders of pregnancy in living donors. For most donors, the 15-year risk of kidney failure is less than 1%, but for certain populations this risk may be higher. New tools such as genetic kidney disease panels may assist with risk stratification. Living kidney donors generally have similar or improved psychosocial health following donation compared to prior to donation and nondonor experience. Postdonation care allows for preventative care measures to mitigate risk as well as ongoing surveillance of donor outcomes. Continuing efforts to capture and report outcomes of living donation are necessary to safely expand living donation worldwide.

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2025-01-27
2025-02-07
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Literature Cited

  1. 1.
    Zazoulina J, Khehra K, Gill J. 2022.. Motivators and barriers to living donor kidney transplant as perceived by past and potential donors. . Can. J. Kidney Health Dis. 9::20543581221137179
    [Google Scholar]
  2. 2.
    Nemati E, Einollahi B, Lesan Pezeshki M, et al. 2014.. Does kidney transplantation with deceased or living donor affect graft survival?. Nephrourol. Mon. 6::e12182
    [Google Scholar]
  3. 3.
    Skrekas G, Papalois VE, Mitsis M, Hakim NS. 2003.. Laparoscopic live donor nephrectomy: a step forward in kidney transplantation?. J. Soc. Laparoendosc. Surg. 7::197206
    [Google Scholar]
  4. 4.
    Kaplow K, Ruck JM, Levan ML, et al. 2024.. National attitudes toward living kidney donation in the United States: results of a public opinion survey. . Kidney Med. 6::100788
    [Google Scholar]
  5. 5.
    Glob. Obs. Donation Transplant. 2016.. Global data. Database, Glob. Obs. Donation Transplant. Accessed March 31, 2024. https://www.transplant-observatory.org/
    [Google Scholar]
  6. 6.
    Lentine KL, Smith JM, Lyden GR, et al. 2024.. OPTN/SRTR 2022 annual data report: kidney. . Am. J. Transplant. 24::S19118
    [Google Scholar]
  7. 7.
    Lentine KL, Kasiske BL, Levey AS, et al. 2017.. KDIGO Clinical Practice Guideline on the evaluation and care of living kidney donors. . Transplantation 101::S1109
    [Google Scholar]
  8. 8.
    Mandelbrot DA, Pavlakis M, Danovitch GM, et al. 2007.. The medical evaluation of living kidney donors: a survey of US transplant centers. . Am. J. Transplant. 7::233343
    [Google Scholar]
  9. 9.
    Lentine KL, Lam NN, Segev DL. 2019.. Risks of living kidney donation: current state of knowledge on outcomes important to donors. . Clin. J. Am. Soc. Nephrol. 14::597608
    [Google Scholar]
  10. 10.
    Lam NN, Lloyd A, Lentine KL, et al. 2020.. Changes in kidney function follow living donor nephrectomy. . Kidney Int. 98::17686
    [Google Scholar]
  11. 11.
    Augustine JJ, Arrigain S, Mandelbrot DA, et al. 2021.. Factors associated with residual kidney function and proteinuria after living kidney donation in the United States. . Transplantation 105::37281
    [Google Scholar]
  12. 12.
    Garg AX, Muirhead N, Knoll G, et al. 2006.. Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression. . Kidney Int. 70::180110
    [Google Scholar]
  13. 13.
    Glassock RJ, Winearls C. 2008.. Screening for CKD with eGFR: doubts and dangers. . Clin. J. Am. Soc. Nephrol. 3::156368
    [Google Scholar]
  14. 14.
    Cheng XS, Glassock RJ, Lentine KL, et al. 2017.. Donation, not disease! A multiple-hit hypothesis on development of post-donation kidney disease. . Curr. Transplant. Rep. 4::32026
    [Google Scholar]
  15. 15.
    Muzaale AD, Massie AB, Wang MC, et al. 2014.. Risk of end-stage renal disease following live kidney donation. . JAMA 311::57986
    [Google Scholar]
  16. 16.
    Anjum S, Muzaale AD, Massie AB, et al. 2016.. Patterns of end-stage renal disease caused by diabetes, hypertension, and glomerulonephritis in live kidney donors. . Am. J. Transplant. 16::354047
    [Google Scholar]
  17. 17.
    Matas AJ, Berglund DM, Vock DM, Ibrahim HN. 2018.. Causes and timing of end-stage renal disease after living kidney donation. . Am. J. Transplant. 18::114050
    [Google Scholar]
  18. 18.
    Grams ME, Sang Y, Levey AS, et al. 2016.. Kidney-failure risk projection for the living kidney-donor candidate. . New Engl. J. Med. 374::41121
    [Google Scholar]
  19. 19.
    Doshi MD, Ortigosa-Goggins M, Garg AX, et al. 2018.. APOL1 genotype and renal function of black living donors. . J. Am. Soc. Nephrol. 29::130916
    [Google Scholar]
  20. 20.
    Lentine KL, Mannon RB. 2020.. Apolipoprotein L1: role in the evaluation of kidney transplant donors. . Curr. Opin. Nephrol. Hypertens. 29::64555
    [Google Scholar]
  21. 21.
    Caliskan Y, Lee B, Whelan A, et al. 2022.. Evaluation of genetic kidney diseases in living donor kidney transplantation: towards precision genomic medicine in donor risk assessment. . Curr. Transplant. Rep. 9::12742
    [Google Scholar]
  22. 22.
    Mjøen G, Hallan S, Hartmann A, et al. 2014.. Long-term risks for kidney donors. . Kidney Int. 86::16267
    [Google Scholar]
  23. 23.
    Thomas CP, Daloul R, Lentine KL, et al. 2023.. Genetic evaluation of living kidney donor candidates: a review and recommendations for best practices. . Am. J. Transplant. 23::597607
    [Google Scholar]
  24. 24.
    Hoy WE, Hughson MD, Bertram JF, et al. 2005.. Nephron number, hypertension, renal disease, and renal failure. . J. Am. Soc. Nephrol. 16::255764
    [Google Scholar]
  25. 25.
    Shah PH, Leibovich BC, Van Houten H, et al. 2019.. Association of partial versus radical nephrectomy with subsequent hypertension risk following renal tumor resection. . J. Urol. 202::6975
    [Google Scholar]
  26. 26.
    Doshi MD, Taler SJ. 2021.. Evaluation of hypertension in living donor candidates. . Living Kidney Donation, , 11939. Cham, Switz.:: Springer
    [Google Scholar]
  27. 27.
    Boudville N, Prasad GV, Knoll G, et al. 2006.. Meta-analysis: risk for hypertension in living kidney donors. . Ann. Intern. Med. 145::18596
    [Google Scholar]
  28. 28.
    Thiel GT, Nolte C, Tsinalis D, et al. 2016.. Investigating kidney donation as a risk factor for hypertension and microalbuminuria: findings from the Swiss prospective follow-up of living kidney donors. . BMJ Open 6::e010869
    [Google Scholar]
  29. 29.
    Sanchez OA, Ferrara LK, Rein S, et al. 2018.. Hypertension after kidney donation: incidence, predictors, and correlates. . Am. J. Transplant. 18::253443
    [Google Scholar]
  30. 30.
    Price AM, Greenhall GHB, Moody WE, et al. 2020.. Changes in blood pressure and arterial hemodynamics following living kidney donation. . Clin. J. Am. Soc. Nephrol. 15::133039
    [Google Scholar]
  31. 31.
    Price AM, Moody WE, Stoll VM, et al. 2021.. Cardiovascular effects of unilateral nephrectomy in living kidney donors at 5 years. . Hypertension 77::127384
    [Google Scholar]
  32. 32.
    Kasiske BL, Anderson-Haag TL, Duprez DA, et al. 2020.. A prospective controlled study of metabolic and physiologic effects of kidney donation suggests that donors retain stable kidney function over the first nine years. . Kidney Int. 98::16875
    [Google Scholar]
  33. 33.
    Garg AX, Arnold JB, Cuerden MS, et al. 2024.. Hypertension and kidney function after living kidney donation. . JAMA 332::28799
    [Google Scholar]
  34. 34.
    Gizem K, Lentine KL. 2024.. Hypertension in living kidney donors: understanding the real risk. . Clin. Kidney J. 17:(9):sfae244
    [Google Scholar]
  35. 35.
    Asgari E, Hilton RM. 2021.. One size does not fit all: understanding individual living kidney donor risk. . Pediatr. Nephrol. 36::25969
    [Google Scholar]
  36. 36.
    Reed RD, McLeod MC, MacLennan PA, et al. 2023.. Change in body mass index and attributable risk of new-onset hypertension among obese living kidney donors. . Ann. Surg. 278::e11522
    [Google Scholar]
  37. 37.
    Helgeson ES, Vempati S, Palzer EF, et al. 2023.. Development and validation of a hypertension risk calculator for living kidney donors. . Transplantation 107::137379
    [Google Scholar]
  38. 38.
    Thomas B, Matsushita K, Abate KH, et al. 2017.. Global cardiovascular and renal outcomes of reduced GFR. . J. Am. Soc. Nephrol. 28::216779
    [Google Scholar]
  39. 39.
    Altmann U, Böger CA, Farkas S, et al. 2017.. Effects of reduced kidney function because of living kidney donation on left ventricular mass. . Hypertension 69::297303
    [Google Scholar]
  40. 40.
    Moody WE, Tomlinson LA, Ferro CJ, et al. 2014.. Effect of A Reduction in glomerular filtration rate after NEphrectomy on arterial STiffness and central hemodynamics: rationale and design of the EARNEST study. . Am. Heart J. 167::14149.e2
    [Google Scholar]
  41. 41.
    Haugen AJ, Hallan S, Langberg NE, et al. 2022.. Increased risk of ischaemic heart disease after kidney donation. . Nephrol. Dial. Transplant. 37::92836
    [Google Scholar]
  42. 42.
    Garg AX, Prasad GV, Thiessen-Philbrook HR, et al. 2008.. Cardiovascular disease and hypertension risk in living kidney donors: an analysis of health administrative data in Ontario, Canada. . Transplantation 86::399406
    [Google Scholar]
  43. 43.
    Garg AX, Meirambayeva A, Huang A, et al. 2012.. Cardiovascular disease in kidney donors: matched cohort study. . BMJ 344::e1203
    [Google Scholar]
  44. 44.
    Segev DL, Muzaale AD, Caffo BS, et al. 2010.. Perioperative mortality and long-term survival following live kidney donation. . JAMA 303::95966
    [Google Scholar]
  45. 45.
    Reese PP, Bloom RD, Feldman HI, et al. 2014.. Mortality and cardiovascular disease among older live kidney donors. . Am. J. Transplant. 14::185361
    [Google Scholar]
  46. 46.
    Chaudry M, Gislason GH, Fosbøl EL, et al. 2020.. Hypertension, cardiovascular disease and cause of death in Danish living kidney donors: matched cohort study. . BMJ Open 10::e041122
    [Google Scholar]
  47. 47.
    Grupper A, Angel Y, Baruch A, et al. 2019.. Long term metabolic and renal outcomes of kidney donors compared to controls with excellent kidney function. . BMC Nephrol. 20::30
    [Google Scholar]
  48. 48.
    Janki S, Dehghan A, van de Wetering J, et al. 2020.. Long-term prognosis after kidney donation: a propensity score matched comparison of living donors and non-donors from two population cohorts. . Eur. J. Epidemiol. 35::699707
    [Google Scholar]
  49. 49.
    Kim Y, Yu MY, Yoo KD, et al. 2020.. Long-term mortality risks among living kidney donors in Korea. . Am. J. Kidney Dis. 75::91925
    [Google Scholar]
  50. 50.
    Munch P, Christiansen CF, Birn H, et al. 2021.. Is the risk of cardiovascular disease increased in living kidney donors? A Danish population-based cohort study. . Am. J. Transplant. 21::185765
    [Google Scholar]
  51. 51.
    Krishnan N, Mumford L, Lipkin G, et al. 2020.. Comparison of medium-term outcomes of living kidney donors with longitudinal healthy control in the United Kingdom. . Transplantation 104::e6574
    [Google Scholar]
  52. 52.
    Swarup S, Goyal A, Grigorova Y, Zeltser R. 2024.. Metabolic syndrome. . StatPearls. https://www.statpearls.com/point-of-care/25039
    [Google Scholar]
  53. 53.
    Mustian MN, Kumar V, Hanaway M, et al. 2019.. Donation approval among obese living kidney donor candidates: the impact of metabolic syndrome. . Surgery 166::94046
    [Google Scholar]
  54. 54.
    Holscher CM, Bae S, Thomas AG, et al. 2019.. Early hypertension and diabetes after living kidney donation: a national cohort study. . Transplantation 103::121623
    [Google Scholar]
  55. 55.
    Tanriover B, Lingvay I, Ahmed F, et al. 2021.. Insulin sensitivity after living donor nephrectomy. . Transplant. Proc. 53::185864
    [Google Scholar]
  56. 56.
    Shehab-Eldin W, Shoeb S, Khamis S, et al. 2009.. Susceptibility to insulin resistance after kidney donation: a pilot observational study. . Am. J. Nephrol. 30::37176
    [Google Scholar]
  57. 57.
    Wuttiputhanun T, Udomkarnjananun S, Hanprathet N, et al. 2023.. Metabolic effects of kidney donation: a Bayesian analysis of matched cohorts. . Nephrology 28::14853
    [Google Scholar]
  58. 58.
    Lentine KL, Koraishy FM, Sarabu N, et al. 2019.. Associations of obesity with antidiabetic medication use after living kidney donation: an analysis of linked national registry and pharmacy fill records. . Clin. Transplant. 33::e13696
    [Google Scholar]
  59. 59.
    Locke JE, Reed RD, Massie A, et al. 2017.. Obesity increases the risk of end-stage renal disease among living kidney donors. . Kidney Int. 91::699703
    [Google Scholar]
  60. 60.
    Orandi BJ, Lofton H, Montgomery RA, Segev DL. 2024.. Antiobesity pharmacotherapy to facilitate living kidney donation. . Am. J. Transplant. 24::32837
    [Google Scholar]
  61. 61.
    Kremers HM, Grossardt BR, Miller AR, et al. 2024.. Fracture risk among living kidney donors 25 years after donation. . JAMA Netw. Open 7::e2353005
    [Google Scholar]
  62. 62.
    Kasiske BL, Kumar R, Kimmel PL, et al. 2016.. Abnormalities in biomarkers of mineral and bone metabolism in kidney donors. . Kidney Int. 90::86168
    [Google Scholar]
  63. 63.
    Garg AX, Pouget J, Young A, et al. 2012.. Fracture risk in living kidney donors: a matched cohort study. . Am. J. Kidney Dis. 59::77076
    [Google Scholar]
  64. 64.
    Bin Mohamed Ebrahim ME, Singla A, Yao J, et al. 2023.. Outcomes of live renal donors with a history of nephrolithiasis; a systematic review. . Transplant. Rev. 37::100746
    [Google Scholar]
  65. 65.
    Thomas SM, Lam NN, Welk BK, et al. 2013.. Risk of kidney stones with surgical intervention in living kidney donors. . Am. J. Transplant. 13::293544
    [Google Scholar]
  66. 66.
    Rule AD, Lieske JC, Li X, et al. 2014.. The ROKS nomogram for predicting a second symptomatic stone episode. . J. Am. Soc. Nephrol. 25::287886
    [Google Scholar]
  67. 67.
    Ibrahim HN, Akkina SK, Leister E, et al. 2009.. Pregnancy outcomes after kidney donation. . Am. J. Transplant. 9::82534
    [Google Scholar]
  68. 68.
    Reisaeter AV, Roislien J, Henriksen T, et al. 2009.. Pregnancy and birth after kidney donation: the Norwegian experience. . Am. J. Transplant. 9::82024
    [Google Scholar]
  69. 69.
    van Buren MC, Meinderts JR, Oudmaijer CAJ, et al. 2023.. Long-term kidney and maternal outcomes after pregnancy in living kidney donors. . Transplant. Int. 36::11181
    [Google Scholar]
  70. 70.
    Garg AX, Nevis IF, McArthur E, et al. 2015.. Gestational hypertension and preeclampsia in living kidney donors. . New Engl. J. Med. 372::12433
    [Google Scholar]
  71. 71.
    Lee J, Huh KH, Yoon SR, et al. 2022.. Pregnancy outcomes after living kidney donation from a nationwide population-based cohort study from Korea. . Sci. Rep. 12::22412
    [Google Scholar]
  72. 72.
    Yoo KD, Lee H, Kim Y, et al. 2018.. Maternal and fetal outcomes of pregnancies in kidney donors: a 30-year comparative analysis of matched non-donors in a single center. . Kidney Res. Clin. Pract. 37::35665
    [Google Scholar]
  73. 73.
    Bellos I, Pergialiotis V. 2022.. Risk of pregnancy complications in living kidney donors: a systematic review and meta-analysis. . Eur. J. Obstet. Gynecol. Reprod. Biol. 270::3541
    [Google Scholar]
  74. 74.
    Artan AS, Fleetwood V, Guller N, et al. 2023.. Pregnancy in living kidney donors: an evidence-based review. . Curr. Transplant. Rep. 10::11016
    [Google Scholar]
  75. 75.
    Lentine KL, Segev DL. 2017.. Understanding and communicating medical risks for living kidney donors: a matter of perspective. . J. Am. Soc. Nephrol. 28::1224
    [Google Scholar]
  76. 76.
    Wirken L, van Middendorp H, Hooghof CW, et al. 2015.. The course and predictors of health-related quality of life in living kidney donors: a systematic review and meta-analysis. . Am. J. Transplant. 15::304154
    [Google Scholar]
  77. 77.
    Lentine KL, Schnitzler MA, Xiao H, et al. 2012.. Depression diagnoses after living kidney donation: linking U.S. registry data and administrative claims. . Transplantation 94::7783
    [Google Scholar]
  78. 78.
    Clemens K, Boudville N, Dew MA, et al. 2011.. The long-term quality of life of living kidney donors: a multicenter cohort study. . Am. J. Transplant. 11::46369
    [Google Scholar]
  79. 79.
    Vital A, Siman-Tov M, Shlomai G, et al. 2024.. Assessing health-related quality of life in non-directed versus directed kidney donors: implications for the promotion of non-directed donation. . Transplant Int. 37::12417
    [Google Scholar]
  80. 80.
    Lentine KL, Mannon RB, Mandelbrot D. 2022.. Understanding and overcoming financial risks for living organ donors. . Am. J. Kidney Dis. 79::15961
    [Google Scholar]
  81. 81.
    Larson DB, Wiseman JF, Vock DM, et al. 2019.. Financial burden associated with time to return to work after living kidney donation. . Am. J. Transplant. 19::2047
    [Google Scholar]
  82. 82.
    Park S, Park J, Kang E, et al. 2022.. Economic impact of donating a kidney on living donors: a Korean cohort study. . Am. J. Kidney Dis. 79::17584.e1
    [Google Scholar]
  83. 83.
    AST (Am. Soc. Transplant.). 2024.. Living donor circle of excellence. . American Society of Transplantation. https://www.livingdonorcircle.com/become-a-member
    [Google Scholar]
  84. 84.
    OPTN (Organ Procure. Transplant. Netw.). 2024.. Data submission requirements. Policy 18 , OPTN, US Dep. Health Hum. Serv., Washington, DC:. http://optn.transplant.hrsa.gov/governance/policies/
    [Google Scholar]
  85. 85.
    Alvarado F, Cervantes CE, Crews DC, et al. 2022.. Examining post-donation outcomes in Hispanic/Latinx living kidney donors in the United States: a systematic review. . Am. J. Transplant. 22::173753
    [Google Scholar]
  86. 86.
    Lam NN, Lentine KL, Hemmelgarn B, et al. 2018.. Follow-up care of living kidney donors in Alberta, Canada. . Can. J. Kidney Health Dis. 5::2054358118789366
    [Google Scholar]
  87. 87.
    Dhalla A, Lloyd A, Lentine KL, et al. 2023.. Long-term outcomes for living kidney donors with early guideline-concordant follow-up care: a retrospective cohort study. . Can. J. Kidney Health Dis. 10::20543581231158067
    [Google Scholar]
  88. 88.
    Gibney EM, Doshi MD, Hartmann EL, et al. 2010.. Health insurance status of US living kidney donors. . Clin. J. Am. Soc. Nephrol. 5::91216
    [Google Scholar]
  89. 89.
    Kasiske BL, Asrani SK, Dew MA, et al. 2017.. The Living Donor Collective: a scientific registry for living donors. . Am. J. Transplant. 17::304048
    [Google Scholar]
  90. 90.
    Kasiske BL, Ahn YS, Conboy M, et al. 2021.. Outcomes of living kidney donor candidate evaluations in the Living Donor Collective pilot registry. . Transplant. Direct 7::e689
    [Google Scholar]
  91. 91.
    Kasiske BL, Lentine KL, Ahn Y, et al. 2022.. OPTN/SRTR 2020 annual data report: Living Donor Collective. . Am. J. Transplant. 22:(Suppl. 2):55386
    [Google Scholar]
  92. 92.
    Lentine KL, Dew MA, Xiao H, et al. 2023.. Factors enabling transplant program participation in the Scientific Registry of Transplant Recipients (SRTR) Living Donor Collective: a national survey. . Clin. Transplant. 37::e14908
    [Google Scholar]
  93. 93.
    Lentine KL, Waterman AD, Cooper M, et al. 2025.. Expanding opportunities for living donation: recommendations from the 2023 Santander Summit to ensure donor protections, informed decision making, and equitable access. . Transplantation 109:(1):2235
    [Google Scholar]
  94. 94.
    Rossi AP, Katz-Greenberg G, Coscia L, . 2024.. Living donation and pregnancy-related complications: state of the evidence and call to action for improved risk assessment. . Clin. J. Am. Soc. Nephrol. 19:(12):165970
    [Google Scholar]
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