18-year follow-up of kidney donation in the living donor transplant program at a reference pediatric hospital
Alfonso Navarro-González1, Monserrat Arreola-Gutiérrez1, José M Zertuche-Coindreau1, Juan C Barrera-De León2, María J Ruiz-López3, Ana B Calderón-Alvarado3, Mitzi R Becerra-Moscoso3.
1Transplant-Urology and Nephrology Department, Hospital de Pediatría CMNO IMSS, Guadalajara, , Mexico; 2Research and Teaching Department, Hospital de Pediatría CMNO IMSS, Guadalajara, , Mexico; 3Pediatric Surgery Department, Hospital de Pediatría CMNO IMSS, Guadalajara, , Mexico
Introduction: The frequency of living donor transplant has recently increased for several reasons. On one hand, due to the increased prevalence of advanced chronic kidney disease and the decrease in the number of suitable brain-dead donors, and on the other hand, due to the improvement in the safety of the procedure for the donor. Since the primary objective of living-donor kidney transplantation is to guarantee the safety of the donor, the scientific community has recently become interested in the possible long-term complications of kidney donation, since follow-up information on the health of donors is essential for understanding the risks and consequences of donation, support donation selection and provide informed consent. The objective of this study is to evaluate the evolution after nephrectomy of the living donor population in a reference pediatric hospital.
Methods: A cross-sectional study of the living donor’s outpatient database was carried out from October 2002 to December 2021. All donors who completed donation in this period of time were included. Surgical time, transoperative incidents, hospital stay, post-surgical complications and long-term behavior of creatinine clearance and proteinuria were analyzed.
Results: A total of 1332 patients who entered the living donor kidney transplant program were analyzed, 796 completed donation (59.75%) and 43 lost follow-up (5.4%). Of the remaining 753 donors, 409 were women (54.31%) and 344 men (45.68%). A total of 702 patients underwent left nephrectomy (93.22%), 50 right nephrectomy (6.64%), and one patient was suspended before completing surgery (0.13%). The median age at nephrectomy was 37.068 years (r=18-56 yrs). The mean surgical time was 128.77 minutes (r=25-170 min). Among transoperative incidents, 125 pleural and/or peritoneum openings (16.60%), 10 kidney decapsulations (1.32%), 9 tearings of different vessels (1.19%), 1 adrenal vessel avulsion (0.13%), and 1 ureteral injury (0.13%) were described. There was one case of cardiorespiratory arrest in the recovery area. The mean days of hospital stay were 2.64 days (r=1-32 days). Creatinine clearance and proteinuria levels were analyzed during a follow-up period of up to 18 years. 96 patients (12.74%) had a sustained decrease in creatinine clearance and proteinuria (>150 mg/d) was found in 16 patients (2.12%). There were 2 donor deaths, none of theme related to renal failure.
Conclusions: Although some increases in urinary protein levels and decreases in creatinine clearance were described, none of our living donors developed kidney failure. Of the 2 reported deaths, one was attributed to colon cancer and the other to alcoholic pancreatitis consequences, none of them related to donation. We can conclude that nephrectomy for donation purposes is a safe procedure since we found no decrease in long-term survival or progressive renal dysfunction.
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