Prevalence of abdominal aortic calcifications in older living renal donors and its effect on graft function and histology

We assessed the prevalence of abdominal aortic calcification (AAC) in older living kidney donors and its effect on recipient eGFR and graft histology. A total of 292 consecutive living pairs with donor age ≥50 from 2003 to 2013 were identified (mean age 56; range 50–78; F/M: 1.8). Donor AAC was determined by prenephrectomy unenhanced CT. Recipient eGFR and spot urine protein: creatinine ratios (UPCRs) were recorded. A total of 180 recipients had 6‐month protocol biopsies. AAC was present in 40.7% of donors, and they were older (58.6 versus 54.7 years old, P < 0.0001) and more likely to be male (77.6% vs. 37.3%, P = 0.004). There was no significant difference in eGFR or spot UPCR up to 36 months in recipients of allografts from donors with versus without AAC. At 6‐month biopsy, there was a higher percentage of allografts with vascular fibrous intimal thickening and arteriolar hyaline thickening from donors with versus without AAC (vascular fibrous intimal thickening: 38.8% vs. 7.1% and arteriolar hyaline thickening: 35.8% vs. 7.1%; P < 0.001 for both). The presence of donor AAC predicts the presence of vascular disease [vascular fibrous intimal thickening (OR: 7.2; CI:2.9–17.9) and arteriolar hyaline thickening (OR:5.7; CI:2.3–14.1)] in allografts at 6 months. Donor AAC is predictive of renal vascular disease and may help to improve the screening of potential donors and inform post‐transplant management.     

Nonresident living kidney donors

INTRODUCTION: The increasing number of immigrant residents has resulted in more foreign patients on the kidney transplant waiting list. While the willingness of their relatives to participate in a living kidney donation program is not different from that of relatives of autochthonous patients, many extra logistic and financial problems have to be solved, when the potential donor has to travel to Rotterdam. The fear of the authorities that the donor might stay in the Netherlands after donation is another hurdle. METHODS AND RESULTS: We analysed 395 living kidney transplantations performed in Rotterdam from 1981 to 2003. In 32 instances the donor came from abroad. Another 14 potential foreign donors came to Rotterdam but did not donate for various reasons. We calculated the costs for visa, travel, insurance, and loss of income. Total financial impact for the 46 (potential) donors, amounted to capital JE, Ukrainian 56,604.09, which is capital JE, Ukrainian 1768.88 per actual performed donation. One kidney donor remained illegally in the Netherlands. CONCLUSION: We conclude that the efforts and support for foreign kidney donors to come to the Netherlands is justified and cost-effective. No evidence was found for a kidney donation immigration route.     

Association between AST-120 and abdominal aortic calcification in predialysis patients with chronic kidney disease

Background

Vascular calcification is associated with mortality and cardiovascular events in patients with chronic kidney disease. AST-120, which adsorbs uremic toxins, is reported to reduce the risk of cardiovascular disease and death in chronic kidney disease patients. The aim of the current study was to investigate the association between abdominal aortic calcification and the use of AST-120 in predialysis chronic kidney disease patients.

Methods

A retrospective analysis was conducted including 199 predialysis chronic kidney disease patients (stages 4 and 5) who underwent abdominal plain computed tomography in our institution between 2005 and 2010. Abdominal aortic calcification was assessed by aortic calcification index (ACI). Patients were divided into two groups based on whether or not AST-120 was administered for at least six months, and ACI was compared between the two groups.

Results

The aortic calcification index was significantly lower in patients taking AST-120 [12.2 (2.5–30.3) vs. 25.7 (13.4–45.3) %, P < 0.001]. According to multivariate linear regression analysis, the use of AST-120 was independently and significantly correlated with ACI after adjusting for confounding factors.

Conclusions

The use of AST-120 was independently associated with less aortic calcification in predialysis chronic kidney disease patients.     

Risks and quality-of-life changes in living kidney donors

INTRODUCTION: Although the benefits of living donor organs for recipients are well documented, the risks and quality-of-life changes in living kidney donors are seldom reported. METHODS: From July 1992 to June 2002, all living kidney donors underwent regular follow-up at our hospital. The MOS 36-item short-form health survey (SF-36), a standardized questionnaire to measure quality of life, was used in this study. Furthermore, donor renal function and associate complications were assessed. RESULTS: Seventeen donors answered the questionnaire, including eight men and nine women of mean age of 41 years (range = 25 to 56). No perioperative mortality was noted. No proteinuria or hematuria was found during long-term follow-up. The mean serum creatinine level was 0.95 +/- 0.22 mg/dL before the operation. The postoperative mean serum creatinine levels at 6 months, 1 year, and 3 years were 1.22 +/- 0.34, 1.19 +/- 0.20, and 1.29 +/- 0.21 mg/dL, respectively. Two cases underwent scar revision and one complained long-term wound pain for more than 1 year. One donor became depressed because of graft failure in her son. The SF-36 scores were 84.4 +/- 4.4 (physical function), 84.0 +/- 4.7 (role-physical), 78.4 +/- 8.0 (body pain), 81.5 +/- 5.9 (general health), 83.2 +/- 3.7 (vitality), 83.9 +/- 5.9 (social functioning), 79.9 +/- 4.1 (role-emotional), and 78.6 +/- 2.3 (mental health), respectively. CONCLUSION: The quality-of-life changes and risks after donation are low; most donors are concerned about cosmetic problems and pain-related scar formation.     

Risk of ESRD in prior living kidney donors

We studied End‐Stage Renal Disease (ESRD) in living kidney donors (LKDs) who donated in the United States between 1994 and 2016 (n = 123 526), using Organ Procurement and Transplantation Network and Centers for Medicare and Medicaid Services data. Two hundred eighteen LKDs developed ESRD, with a median of 11.1 years between donation and ESRD. Absolute 20‐year risk was low but not uniform, with risk associated with race, age, and sex and increasing exponentially over time. LKDs had increased risk of ESRD if they were male (adjusted hazard ratio [aHR]: 1.75, 95% confidence interval [95%CI]: 1.33‐2.31), had higher BMI (aHR: 1.34 per 5 kg/m², 95%CI: 1.10‐1.64) or lower estimated GFR (aHR: 0.89 per 10 mL/min, 95% CI: 0.80‐0.99), were first‐degree relatives of the recipient (parent: [aHR: 2.01, 95% CI: 1.26‐3.21]; full sibling [aHR: 1.87, 95%CI: 1.23‐2.84]; identical twin [aHR: 19.79, 95%CI: 7.65‐51.24]), or lived in lower socioeconomic status neighborhoods at donation (aHR: 0.87 per $10k increase; 95%CI: 0.77‐0.99). We found a significant interaction between donation age and race, with higher risk at older ages for white LKDs (aHR: 1.26 per decade, 95%CI: 1.04‐1.54), but higher risk at younger ages for black LKDs (aHR: 0.75 per decade, 95%CI: 0.57‐0.99). These findings further inform risk assessment of potential LKDs.     

Lack of health insurance in living kidney donors

Living donors are recommended to receive lifelong routine health maintenance after donation. There has been little examination of health insurance status among living donors, despite the fact that lack of health insurance is likely to impede donors' ability to obtain long-term healthcare post-donation. We performed a retrospective chart review for all living kidney donors at our institution between 2004 and 2008 to determine insurance status, demographic, socioeconomic, and basic health characteristics. Twenty-three percent of donors were uninsured at the time of donation. Odds of being uninsured were significantly lower in donors who were older than 40 yr of age or who had at least a college education, and significantly higher in donors who were non-white, non-English-speaking, or non-US citizens. Odds of being uninsured did not differ according to whether donors were obese, hypertensive, or smokers. On multivariate analysis, only non-white race, non-US citizenship, and education level less than a college degree were associated with lack of insurance. Lack of health insurance is more prevalent in living kidney donors than in the general US population. Its disproportionate impact on minorities, non-citizens, and the less well educated is greater than that in the general population.     

219例活体肾移植供者长期随访分析

目的 探讨活体肾移植供者术后生存质量及恢复情况.方法 对2004年以来219例肾脏捐献超过1年的亲属活体肾移植供者进行随访,评估供者的肾功能、并发症发生情况及生活质量.结果 供者捐肾时年龄为(43.3±11.6)岁(19～66岁),随访时间为术后12～103个月,随访截止时供者存活率为100％.术后稳定期(1年后)供者血清肌酐(Scr)为(84.0±18.7)μmol/L,内生肌酐清除率(Ccr)为(1.23±0.37)ml/s.＞50岁者术后1周及1年后Ccr低于年龄≤50岁者(P＜0.01,P＜0.05).3例供者术后Scr未降至正常范围,其肾脏捐献时年龄＞55岁.术后并发症包括高血压30例(其中5例为术后新发),镜下血尿4例,高脂血症3例,轻度贫血2例,股骨头坏死1例.总体感觉肾脏捐献对健康有影响者共40例,认为肾脏捐献对健康有轻度影响者31例,有较明显影响者7例,有严重影响者2例;偶尔觉伤口疼痛31例,经常感觉伤口疼痛4例.结论 供者肾脏捐献后中长期安全性和生存质量良好,但仍存在肾功能异常风险,尤其是高龄供者,需密切随访.供者随访依从性需进一步提高.     

Very long-term follow-up of living kidney donors

Knowledge of the very long-term consequences of kidney donors has not been previously reported extensively. The 398 persons who had donated a kidney between 1952 and 2008 at Necker hospital were contacted. Among the 310 donors who were located, the survival probabilities for this population were similar to those of the general population and end stage renal disease incidence was 581 per million population per year. All located donors still alive were asked to complete a medico-psychosocial questionnaire and give samples for serum creatinine and urinary albumin assays. Among the 204 donors who responded to the questionnaire, mean eGFR was 64.4±14.6ml/min per 1.73m(2) and mean microalbuminuria was 27.0±83mg/g. Most donors never regretted the donation and consider that it has no impact on their professional or social lives. Among the 59 donors who gave a kidney more than 30years ago (mean 40.2years, range 30-48years) had a mean eGFR of 67.5±17.4μmol/l, a mean microalbuminuria level of 44.8±123.2mg/g and none was dialyzed. In conclusion, living kidney donation does not impact survival, kidney function, medical condition or psychological or social status over the very long-term.     

活体捐肾者的医学风险分析

绝大多数的捐肾者在其整个生命周期里是安全的,但也面临一些医学风险。多项循证医学证据分析显示,捐肾后蛋白尿发生率为10%。捐肾可使微量白蛋白尿的发生风险增加3.9倍。捐肾后10年高血压发病率为9%～36%,需使用降压药的比例为9%～15%,收缩压较术前升高6mmHg(1mmHg=0.133kPa),舒张压较术前升高4mmHg。捐肾可使血压升高的风险增高1.9倍,但捐肾不增加心血管事件发生率。捐肾者终末期肾功能衰竭发生率0.04%,原因主要有高血压(35.71%)、局灶性肾小球硬化(16.07%)、慢性肾盂肾炎(12.50%)、糖尿病(3.57%)等。捐肾后6年时肾小球滤过率较术前下降了26mL·min-1·(1.73m2)-1,捐肾后12年时85.5%的捐肾者肾小球滤过率在60mL·min-1·(1.73m2)-1以上。因此,有必要提高医患双方对捐肾长期安全性的认识,加强监控,及时采取有针对性的肾脏保护性治疗措施。     

Long-term risk of hypertension and chronic kidney disease in living kidney donors

Objective

The aim of this study was to assess the long-term risks of chronic kidney disease and arterial hypertension in living kidney donors.

Methods

Donors who were followed for more than 1 year after nephrectomy were included. We assessed each donor's blood pressure, urine protein, and estimated glomerular filtration rate (eGFR).

Results

The follow-up rate was 11% (154 out of 1,356 donors), only 19% of whom were followed by nephrologists. Blood pressure had increased from 113/75 to 116/77 mm Hg (P < .01), urinary protein excretion after donation did not increase, and renal function was well preserved after donor nephrectomy. However, 33 patients (21.4%) showed a decreased eGFR of <60 mL/min/1.73 m², and 3 donors developed end-stage renal disease that required renal replacement therapy.

Conclusions

The follow-up rate of living donors after donation was low, and we observed an increased risk of developing chronic kidney disease after donation.     

Long-term follow-up of the remaining kidney in living related kidney donors

In this work 45 living related kidney donors (LRD) and 20 healthy sex and age matched controls were examined. Donors were evaluated up to 122 months after donation. Hyperfiltration was observed in the remaining kidney with a mean one-kidney GFR value of 82.9±36.8 ml/min while the control value was 71.04±31.5 ml/min. The kidney was significantly larger in the donor group than in the controls. In the LRD group, 3 were hypertensive, 7 showed microscopic haematuria and 5 had mild proteinuria. In the control group 3 were mildly hypertensive, and 2 showed microscopic haematuria. Serum creatinine of the donor group was found to be significantly higher than in the controls, yet it was stable and within the normal range (0.89±0.28 mg/dl). Examination for microalbuminuria showed that 11% of the donor group excreted higher amounts of albumin, being above the upper limit of the control group. We have concluded that kidney donation will result in minor abnormalities in kidney functions which will not affect the donor morbidity or mortality.     

因泌尿系疾病行一侧肾切除者与健康供肾者的安全性对比观察

目的 比较健康供肾者和因泌尿系疾病一侧肾切除者术后理化指标的变化,探讨供肾者的安全性.方法 回顾性分析和比较健康供肾者和因泌尿系疾病一侧肾切除者术前、术后1周、1个月、6个月和1年的血压、肾功能、血常规、尿蛋白、电解质及血脂的变化.其中供肾者组65例,男12例,女53例;因泌尿系疾病行一侧肾切除组354例,包含一侧上尿路肿瘤而切除291例,一侧肾积水无功能而行切除56例,外伤行一侧肾切除7例.结果健康供肾者和泌尿系一侧肾切除者术后1周内在血红蛋白、肌酐、尿素氮、蛋白尿方面,与术前比较,相差显著.术后1个月恢复基本平稳,半年以后,甚至1年后,2组的理化指标进一步接近术前水平,但肌酐与术前相比,仍相差显著,健康供肾者上升25.71%,泌尿系疾病单侧肾切除者上升25.49%,均在正常范围.术后1年比较,两组间相差不显著.结论 健康供肾者和泌尿系一侧肾切除者术后是安全的,理化指标的变化相差不显著,但严格筛选供者、仔细术前检查、细致手术操作、术后随访指导,对供肾者,特别是年长供肾者的安全健康具有重要意义.