Kidney Donor Mortality Plummets Over 30 Years

TOPLINE:

The risk for perioperative mortality among living kidney donors has significantly declined over the past 30 years, with the most recent decade showing less than one death per 10,000 donations. Male donors and those with a history of hypertension are found to have higher mortality risks.

METHODOLOGY:

• With evolving treatment trends in donor selection, perioperative care, and surgical technique, prior estimates of perioperative mortality may not reflect current risks. It’s important for living kidney donor candidates to be informed of these updated risks.
• The researchers analyzed data from the Scientific Registry of Transplant Recipients on 164,593 living kidney donors from 1993 to 2022.
• Mortality ratios within 90 days of donation were calculated and stratified across three eras: 1993-2002, 2003-2012, and 2013-2022.
• Death events were captured from multiple sources, including the Organ Procurement & Transplantation Network (OPTN) and the Limited Access Death Master File provided by the National Technical Information Service.
• Mortality risk was compared across subgroups by age, sex, race and ethnicity, type of procedure, body mass index, and history of hypertension.

TAKEAWAY:

• The risk for perioperative mortality among living kidney donors was comparable in 1993-2002 (3.0 per 10,000 donations) and 2003-2012 (2.9 per 10,000 donations) and then declined significantly in 2013-2022 (0.9 per 10,000 donations; P = .01).
• The risk for mortality was higher among male donors than among female donors (4.0 vs 1.0 per 10,000 donations).
• Donors with a history of hypertension had a higher mortality rate than those without a history of hypertension (7.5 vs 1.4 per 10,000 donations; P = .03).
• The risk for mortality was higher for donors who underwent open procedures (4.3 per 10,000 donations) than for those who underwent laparoscopic procedures (1.9 per 10,000 donations), although this difference was not statistically significant.

IN PRACTICE:

“Perioperative mortality after living donation declined substantially in the past decade compared with prior decades to fewer than one event per 10,000 donations,” the authors wrote. “Current guidelines for donor informed consent, based on 2009 data, should be updated to reflect this information,” they added.

SOURCE:

The study was led by Allan B. Massie, PhD, Department of Surgery, NYU Langone Health, New York City. It was published online on August 28, 2024, in JAMA.

LIMITATIONS: 

The study’s power to estimate relative risks was limited due to the small number of perioperative deaths over 30 years. Additionally, follow-up may be incomplete, although stricter OPTN requirements since 2013 may have mitigated this issue.

DISCLOSURES:

The study was supported by the National Institute of Diabetes and Digestive and Kidney Diseases and the National Institute of Allergy and Infectious Diseases. Some authors reported receiving grants from the National Institutes of Health or compensation such as speaker fees, honoraria, or consulting fees from various pharmaceutical companies. One author reported serving as the director of the Scientific Registry of Transplant Recipients.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.