Health outcomes among non-Caucasian living kidney donors: knowns and unknowns.

The growth in living kidney donation has been accompanied by greater racial diversity. Most information on post-donation health comes from single-center studies of dominantly Caucasian cohorts. Recent linkage of U.S. donor registration data with death records demonstrated higher mortality risks among African American donors, but importantly, no differences in death compared with demographically matched, healthy controls. Within the donor population, some recent studies have also identified higher likelihoods of post-donation hypertension, diabetes mellitus and kidney failure in African American and Hispanic donors. Thus, based on concerns for higher risks of long-term end-organ damage, it may be reasonable to consider race within the living donor selection process, such as use of more stringent exclusion criteria among non-Caucasian living donors with baseline elevated blood pressure. Recently identified associations of coding variants in the apolipoprotein L1 (APOL1) gene with nondiabetic renal failure in African Americans raise promise of APOL1 genotyping as a novel tool for risk stratifying African American potential donors, but more data are needed to understand implications for post-donation outcomes. To tailor counseling and informed consent, focused attention to long-term medical outcomes among non-Caucasian living donors is needed, and should include assembly of healthy non-donor controls for assessment of attributable risks of donation.