Yaerim Kim1, Mi-Yeon Yu2, Kyung Don Yoo3, Chang Wook Jeong4, Hyeon Hoe Kim4, Sang-Il Min5, Jongwon Ha5, Yunhee Choi6, Ah Ryoung Ko7, Jae Moon Yun7, Sang Min Park7, Seung Hee Yang8, Dong Ki Kim9, Kook-Hwan Oh10, Kwon Wook Joo9, Curie Ahn9, Yon Su Kim9, Hajeong Lee11. 1. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea. 2. Department of Internal Medicine, Hanyang University Guri Hospital, Guri, Republic of Korea. 3. Department of Internal Medicine, Ulsan University Hospital, Ulsan, Republic of Korea. 4. Department of Urology, Seoul National University Hospital, Seoul, Republic of Korea. 5. Department of Surgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Republic of Korea. 6. Medical Research Collaborating Center, Seoul National University, Seoul, Republic of Korea. 7. Department of Family Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 8. Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. 9. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. 10. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea. 11. Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Kidney Research Institute, Seoul National University College of Medicine, Seoul, Republic of Korea. Electronic address: mdhjlee@gmail.com.
Abstract
RATIONALE & OBJECTIVE: Living kidney donors may have a higher risk for death and kidney failure. This study aimed to investigate the long-term mortality experience of living kidney donors compared with members of the general public in Korea who underwent voluntary health examinations. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: We first calculated standardized mortality ratios for 1,292 Korean living kidney donors who underwent donor nephrectomy between 1982 and 2016 and 72,286 individuals who underwent voluntary health examinations between 1995 and 2016. Next we compared survival between the 1,292 living kidney donors and a subgroup of the health examination population (n=33,805) who had no evident contraindications to living kidney donation at the time of their examinations. Last, a matched comparator group was created from the health examination population without apparent contraindication to donation by matching 4,387 of them to donors (n=1,237) on age, sex, body mass index, estimated glomerular filtration rate, urine dipstick albumin excretion, previously diagnosed hypertension and diabetes, and era. EXPOSURES: Donor nephrectomy. OUTCOMES: All-cause mortality and other clinical outcomes after kidney donation. ANALYTICAL APPROACH: First, standardized mortality ratios were calculated separately for living kidney donors and the health examination population standardized to the general population. Second, we used Cox regression analysis to compare mortality between living kidney donors versus the subgroup of the health examination population without evident donation contraindications. Third, we used Cox regression analysis to compare mortality between living kidney donors and matched comparators from the health examination population without apparent contraindication to donation. RESULTS: The living kidney donors and health examination population had excellent survival rates compared with the general population. 52 (4.0%) of 1,292 kidney donors died during a mean follow-up of 12.3±8.1 years and 1,072 (3.2%) of 33,805 in the health examiner subgroup without donation contraindications died during a mean follow-up of 11.4±6.1 years. Donor nephrectomy did not elevate the hazard for mortality after multivariable adjustment in kidney donors and the 33,805 comparators (adjusted HR, 1.01; 95% CI, 0.71-1.44; P=0.9). Moreover, living donors showed a similar mortality rate compared with the group of matched healthy comparators. LIMITATIONS: Donors from a single transplantation center. Residual confounding owing to the observational study design. CONCLUSIONS: Kidney donors experienced long-term rates of death comparable to nondonor comparators with similar health status.
RATIONALE & OBJECTIVE: Living kidney donors may have a higher risk for death and kidney failure. This study aimed to investigate the long-term mortality experience of living kidney donors compared with members of the general public in Korea who underwent voluntary health examinations. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: We first calculated standardized mortality ratios for 1,292 Korean living kidney donors who underwent donor nephrectomy between 1982 and 2016 and 72,286 individuals who underwent voluntary health examinations between 1995 and 2016. Next we compared survival between the 1,292 living kidney donors and a subgroup of the health examination population (n=33,805) who had no evident contraindications to living kidney donation at the time of their examinations. Last, a matched comparator group was created from the health examination population without apparent contraindication to donation by matching 4,387 of them to donors (n=1,237) on age, sex, body mass index, estimated glomerular filtration rate, urine dipstick albumin excretion, previously diagnosed hypertension and diabetes, and era. EXPOSURES: Donor nephrectomy. OUTCOMES: All-cause mortality and other clinical outcomes after kidney donation. ANALYTICAL APPROACH: First, standardized mortality ratios were calculated separately for living kidney donors and the health examination population standardized to the general population. Second, we used Cox regression analysis to compare mortality between living kidney donors versus the subgroup of the health examination population without evident donation contraindications. Third, we used Cox regression analysis to compare mortality between living kidney donors and matched comparators from the health examination population without apparent contraindication to donation. RESULTS: The living kidney donors and health examination population had excellent survival rates compared with the general population. 52 (4.0%) of 1,292 kidney donors died during a mean follow-up of 12.3±8.1 years and 1,072 (3.2%) of 33,805 in the health examiner subgroup without donation contraindications died during a mean follow-up of 11.4±6.1 years. Donor nephrectomy did not elevate the hazard for mortality after multivariable adjustment in kidney donors and the 33,805 comparators (adjusted HR, 1.01; 95% CI, 0.71-1.44; P=0.9). Moreover, living donors showed a similar mortality rate compared with the group of matched healthy comparators. LIMITATIONS: Donors from a single transplantation center. Residual confounding owing to the observational study design. CONCLUSIONS: Kidney donors experienced long-term rates of death comparable to nondonor comparators with similar health status.
Authors: Bertram L Kasiske; Yoon Son Ahn; Michael Conboy; Mary Amanda Dew; Christian Folken; Macey Levan; Ajay K Israni; Krista L Lentine; Arthur J Matas; Kenneth A Newell; Dianne LaPointe Rudow; Allan B Massie; Donald Musgrove; Jon J Snyder; Sandra J Taler; Jeffrey Wang; Amy D Waterman Journal: Transplant Direct Date: 2021-04-22
Authors: Eunjeong Kang; Sehoon Park; Jina Park; Yaerim Kim; Minsu Park; Kwangsoo Kim; Hyo Jeong Kim; Miyeun Han; Jang-Hee Cho; Jung Pyo Lee; Sik Lee; Soo Wan Kim; Sang Min Park; Dong-Wan Chae; Ho Jun Chin; Yong Chul Kim; Yon Su Kim; Insun Choi; Hajeong Lee Journal: Kidney Res Clin Pract Date: 2021-11-05
Authors: Yaerim Kim; Eunjeong Kang; Dong-Wan Chae; Jung Pyo Lee; Sik Lee; Soo Wan Kim; Jang-Hee Cho; Miyeun Han; Seungyeup Han; Yong Chul Kim; Dong Ki Kim; Kwon Wook Joo; Yon Su Kim; Hajeong Lee Journal: Korean J Intern Med Date: 2022-04-13 Impact factor: 3.165