Transplant Trial Watch

Mid- and Long-Term Health Risks in Living Kidney Donors: A Systematic Review and Meta-analysis.

O'Keeffe LM, Ramond A, et al.

Annals of Internal Medicine 2018; 168(4): 276-284.

To conduct a systematic review and meta-analysis to determine the mid and long-term health risks associated with living kidney donation in adults.

The databases PubMed, Embase, Scopus, and PsycINFO were searched without language restrictions from April 1964 to 20 July 2017. Reference lists of relevant articles were also scanned as well as backward and forward citation searching of all included studies. Eligible studies were those that reported associations between living kidney donation and any health outcomes, disease traits, or health related quality of life using a validated instrument, had a mean follow-up after donation ≥ 1 year and provided a comparison group of control participants who had not donated a kidney. Two investigators independently extracted data from included studies and quality was evaluated using the Newcastle Ottawa Scale.

52 studies, comprising 118,426 living kidney donors and 117,656 nondonors, were included in the analysis.

Measured outcomes included all-cause mortality, pregnancy outcomes, health related quality of life, chronic disease end points such as cancer, cardiovascular disease, hypertension, end-stage renal disease and type 2 diabetes, and disease traits such as blood pressure, lipid and metabolic markers and renal function.

1 to 24 years

CET Conclusions
This comprehensive systematic review and meta-analysis explores the longer-term health risks to living kidney donors from the published literature. The authors identified 52 unique studies with at least 1-year follow-up, of which 28 were considered of moderate or greater methodological quality and were published after 2000. Compared to selected control populations, live donors were shown to have similar mortality risk, but lower GFR, higher risk of ESRD and higher diastolic blood pressures. Higher risk of pre-eclampsia was seen in the two studies investigating pregnancy outcomes. The methods used here are appropriate and the study is very thorough. Unfortunately, the underlying data is very heterogeneous (most likely due to different methods for selecting control patients) and most outcomes demonstrate significant heterogeneity with wide confidence intervals. For example, whilst the relative risk of ESRD in donors is reported as 8.83, the 95% confidence interval spans 1.02 to 20.93. Despite these limitations, these data provide useful insight to help clinicians when discussing the risks with potential donors.

Quality notes
Quality assessment not appropriate

Trial registration
PROSPERO - CRD42017072284

Funding source
Non-industry funded