Introduction:
Living kidney donation is a vital component of the global effort to combat end-stage renal disease (ESRD). As the demand for kidney transplants continues to rise, the role of living donors becomes increasingly crucial in providing timely and effective treatment options for patients in need. However, the safety of donor who has shown limitless altruism is paramount and should not expose them to any risk. This study aims to investigate the impact of kidney donation on living donors by examining changes in blood pressure (BP), Body mass index (BMI), and renal function.
Methods:
Herein is a combined observational retrospective and prospective single centre study started in April 2022, reporting the outcomes of 100 donors, all above 18years, who donated in the past decade between 2014-2024. 43 donors were from prospective cohort and 57 donors from retrospective cohort. Pre-donation assessment was done on the basis of age at donation, duration of nephrectomy, DTPA scan, estimated Glomerular Filtration Rater (eGFR)assessment and spot urine protein creatinine ratio (UPCR), Blood pressure and BMI. During follow-up, post-donation BP, BMI and kidney function at 3 months and yearly afterwards.
Results:
100 donors were enrolled into the study. In combined study, 71% were females and 29% were males. 15% of donors were elderly (Age>65 years). Mean and median age at the time of donation were 52.11year and 55 year with maximum age of donation was 84years. Mean follow up was 30.95months with maximum follow-up of 120 months. 14 donors were hypertensive and 12 donors had prediabetes prior to transplantation. Pre-donation mean serum creatinine was 0.68mg/dl with mean GFR of 105.7ml/min/1.73m2. 80% of donors had eGFR of more than 90ml/min/1.73m2. Mean UPCR was 0.10 gm/gm. Mean systolic and diastolic BP was 123.2mmHg and 77.89mmHg respectively. We noticed decline in mean GFR in first 3 months of both men and women with mean eGFR of 75.3ml/min/1.73m2. It has increased to 77.13ml/min/1.73m2 in 1 year and remained stable during later follow ups. Only 6 donors had eGFR<60ml/min/1.73m2. No donor developed overt proteinuria and only one donor developed hypertension after 1 year of donation. In retrospective subgroup, 57 patients were included. Their mean follow up was of 49 months. Mean serum creatinine was 0.97mg/dl with UPCR of 0.17gm/gm. Mean systolic and diastolic blood pressure was 131mmHg and 81mmHg. 5 donors developed hypertension and 2 donor developed diabetes requiring medical management. In another subgroup analysis of elderly donors (>65 years) included 15 donors with mean age at the time of donation of 72 years. 60% of them were males. Mean follow-up of 20.3 months. They had significant fall in GFR from pre-donation to initial 3 months of donation (93ml/min/1.73m2 to 63.3ml/min/1.72m2 respectively). However, there was steady increase of GFR afterwards and was acceptable as per their age. No peri-operative complication was documented.
Conclusions:
Our results show that kidney donation is safe provided that a strict screening is done prior to donation to exclude those who are at increased risk of complications. Lifestyle modification and early detection of co-morbidities after donation is of paramount importance for long term morbidity and mortality of donors.
I have no potential conflict of interest to disclose.
I did not use generative AI and AI-assisted technologies in the writing process.