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Perioperative Complications After Living Kidney Donation: A National Study
Authors:K. L. Lentine  N. N. Lam  D. Axelrod  M. A. Schnitzler  A. X. Garg  H. Xiao  N. Dzebisashvili  J. D. Schold  D. C. Brennan  H. Randall  E. A. King  D. L. Segev
Affiliation:1. Center for Abdominal Transplantation, Saint Louis University School of Medicine, St. Louis, MO;2. Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada;3. Division of Abdominal Transplantation, Department of Surgery, Dartmouth Hitchcock Medical Center, Hanover, NH;4. Division of Nephrology, Western University, London, Ontario, Canada;5. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH;6. Transplant Nephrology, Washington University School of Medicine, St. Louis, MO;7. Division of Transplantation, Department of Surgery, Johns Hopkins School of Medicine, Baltimore, MD
Abstract:We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008–2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14 964 living kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia‐related injuries (2.4%), and “other” complications (6.6%). Major Clavien Classification of Surgical Complications grade IV or higher affected 2.5% of donors. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR 1.26, p = 0.001) and of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p < 0.0001), and grade IV or higher (aOR 1.56, p = 0.004) events. Other significant correlates of Clavien grade IV or higher events included obesity (aOR 1.55, p = 0.0005), predonation hematologic (aOR 2.78, p = 0.0002) and psychiatric (aOR 1.45, p = 0.04) conditions, and robotic nephrectomy (aOR 2.07, p = 0.002), while annual center volume >50 (aOR 0.55, p < 0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure, and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors.
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