J. Jadi1, A. Nayyar2, C. Gaber3, P. D. Strassle3, D. Gerber2, A. Toledo2, P. Serrano2 1University Of North Carolina At Chapel Hill,School Of Medicine,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,Division Of Abdominal Transplant,Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill,School Of Public Health,Chapel Hill, NC, USA
Introduction: Allogenic kidney transplantation is the definitive treatment course for patients with dialysis dependent end-stage renal disease (ESRD). While past research has shown that the overall risk for healthy kidney donors is negligible, there is a growing body of evidence that demonstrates certain donor characteristics may be associated with an increased risk of developing ESRD in a healthy kidney donor. The goal of this study was to assess how donor characteristics including gender, race, history of smoking, and BMI affect the long-term risk of ESRD in kidney donors at an academic medical center.
Methods: Predicted pre-donation 15-year and lifetime risk of end-stage renal disease (ESRD) were calculated for kidney donors between 2006 and 2016 at University of North Carolina Medical Center, using the recently released ESRD Risk Tool for Kidney Donor Candidates (http://www.transplantmodels.com/esrdrisk/). Student’s t-tests were used to compare 15-year and lifetime predicted risk across sex, race, smoking status, and obesity status.
Results: Overall, the 15-year and lifetime predicted risks of ESRD were 0.19% and 1.04%, respectively. Compared to females, males had a higher mean 15-year (0.29% vs. 0.14%, p<0.0001) and lifetime (1.60% vs. 0.72%, p<0.0001) predicted risk of ESRD. Black donors, compared to whites, also had a higher 15-year (0.45% vs. 0.14%, p<0.0001) and lifetime (2.38% vs. 0.76%, p<0.0001) predicted risk of ESRD. Compared to non-smokers, smokers had a higher 15-year (0.28% vs. 0.16%, p<0.0001) and lifetime (1.50% vs. 0.86%, p<0.001) predicted risk of ESRD. No significant increase in ESRD risk was seen among obese patients compared to non-obese patients (15-year risk: 0.24% vs. 0.18%, p=0.08, and lifetime risk: 1.21% vs. 0.99%, p=0.26).
Conclusion: The overall 15 year and lifetime risk of ESRD in kidney donors was minimal (<1.5%). While overall predicted risks were low, certain characteristics were associated with greater percentages. Male gender, current smoking, and race had a significant impact on the 15 year and lifetime predicted risk of ESRD in our patient population. This study highlights the applicability of the novel ESRD risk assessment tool as an aid to the preoperative evaluation in kidney donors. Before allowing an individual to become a donor, these characteristics need to be considered as part of an individualized screening process to ensure that the benefit of the recipient is balanced by the risk for the donor patient.
