KIDNEY FUNCTION DECLINE AND MORTALITY IN DONORS WITH EXPANDED CRITERIA - FIVE YEARS FOLLOW UP STUDY

  • Lada Trajcheska University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Stefan Filipovski University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Igor Nikolov University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Galina Severova University clinic of nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Zaklina Sterjova University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Vlatko Karanfilovski University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Sabir Sulejman University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Emilija Rambabova Faculty of Medical Sciences, GoceDelcev University in Stip, North Macedonia
  • Aleksandra Canevska University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Irena Rambabova Busletikj University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia
  • Goce Spasovski University Clinic of Nephrology, Faculty of Medicine, University Ss. Cyril and Methodius, Skopje, North Macedonia

Abstract

Kidney donors are considered healthy, but with a need for continued medical follow up and encouragement for continued healthy lifestyle, especially when expanded criteria for donation are applied.  This study aims to analyse the five years follow up of kidney donors after explanation, encountering risks of kidney function decline and donors’ mortality. In a retrospective study we evaluated a donor cohort with 5 years of follow up. Demographic characteristics as age, gender and the presence comorbidities as diabetes, hypertension, hyperlipidemia and Body Mass Index (BMI) >30kg/m2 were analyzed. Estimated glomerular filtration rate (eGFR) by CKD EPI formula was notified prior donation, and annually afterwards. Consultations with nephrologist or other specialists were notified. In a multivariate regression analysis, the reduction ratio (RR) of eGFR was explored as dependent variable. Cox regression analysis exploited mortality; Kaplan Meier survival curve was applied in respect of BMI. Seventy-five donors with average age above 55 years were predominantly women (69%), nearly every nineth patient had diabetes or obesity (9%). Proportion of donors referred to nephrologist at the 12 months, declined up to 58% at the fifth year, ignoring medical checks showed ascending trend to 16% at the end of second and third year and 12% at the end of observational period.   The univariate regression analysis found diabetes, hyperlipidemia and hypertension, the presence of multiple comorbidities, gender and age as insignificant predictors of eGFR 12 months reduction ratio. The nephrologist referral showed borderline significance (β = - 0.103, p=0.076). Only BMI over 30kg/m2 worsened the kidney function (β = 0.600, p=0.001). Five years mortality rate was 6.7%. The diseased donors were significantly older, more frequently had diabetes and obesity also they had significantly lower eGFR pre-donation, at the end of the first year but also and more step decline of it after 12 months. In the multivariate analysis BMI>30kg/m2 emerged as most powerful predictor of mortality (HR 40.02; CI: [4.11-389), p=0.0001). Survival of obese patients was significantly shorter when compared with patients with lower body weight (43.28 ± 7.51 vs. 59.33±0.65, Log rank p=0.000), respectively. Our study demonstrates that the mortality and declination of renal function after donation are associated with nephrologist referral and other potentially modifiable factors, especially obesity. Improved protocols for pre-donation information, education and adequate after-donation follow up is mandatory to achieve better longevity and kidney function survival in these frail and precious individuals. 


Key words: donors, kidney function decline, mortality, obesity, nephrologist referral.

References

1. Organ Procurement and Transplantation Network. National Data; available at https://www.organdonor.gov/learn/organ-donation-statistics /# (last accessed 29 Fev 2024).
2. Anderson, D.J., Locke, J.E. Progress towards solving the donor organ shortage. Nat Rev Nephrol 19, 83–84 (2023). https://doi.org/10.1038/s41581-022-00664-y
3. Bastani B. The present and future of transplant organ shortage: some potential remedies. J Nephrol. 2020 Apr;33(2):277-88.
4. Morris T, Maple H, Norton S, Chilcot J, Burnapp L, Draper H et al. Challenges and Opportunities in the Supply of Living Kidney Donation in the UK National Health Service: An Economic Perspective. Transplantation. 2022 Nov 1;106(11):2137-42.
5. Gjorgjievski N, Karanfilovski V. Global Dialysis Perspective: North Macedonia. Kidney360. 2023 Apr 1;4(4):525-9.
6. ERA Annual Reports. Available at: https://www.era-online.org/research-education/era-registry/annual-reports/
7. Popov Z, Kolevski V, Ivanovski N. Use of expanded criteria in living kidney donors – the crucial factor for improvement of the kidney transplant program in Republic of Macedonia. CONTRIBUTIONS. Sec. Med. Sci., XXXV, 2 2014
8. Spasovski GB. First two AB-incompatible living kidney transplantations in the Balkans-should it be a procedure of choice in a developing country? Int J Artif Organs. 2007 Feb;30(2):173-5.
9. Matas AJ, Rule AD. Long-term Medical Outcomes of Living Kidney Donors. Mayo Clin Proc. 202
Nov;97(11):2107-22.
10. MOJ TERMIN. Available form: http://www.mojtermin.mk/health_workers.
11. Segev DL, Muzaale AD, Caffo BS. Perioperative Mortality and Long-term Survival Following Live Kidney Donation. JAMA. 2010;303(10):959–66.
12. Fehrman-Ekholm I., Elinder C., Stenbeck M., Tyden G., Groth C. Kidney donors live longer. Transplantation. 1997;64: 976–8.
13. Ibrahim H., Kukla A., Cordner G., Bailey R., Gillingham K., Matas A. Diabetes after kidney donation. Am J Transplant. 2010;10 :331–7.
14. Okamoto M., Suzuki T., Fujiki M., Nobori S., Ushigome H., Sakamoto S. The consequences for live kidney donors with preexisting glucose intolerance without diabetic complication: analysis at a single Japanese center. Transplantation. 2010;89: 1391–5.
15. Mandelbrot D., Pavlakis M., Danovitch G., Johnson S., Karp S., Khwaja K. The medical evaluation of living kidney donors: a survey of U.S. transplant centers. Am J Transplant. 2007;7: 2333–43.
16. Reese PP, Feldman HI, Asch DA, Thomasson A, Shults J, Bloom RD. Short-term outcomes for obese live kidney donors and their recipients. Transplantation. 2009 Sep 15;88(5):662-71.
17. Yoon YE, Choi KH, Lee KS, Kim KH, Yang SC, Han WK. Impact of metabolic syndrome on postdonation renal function in living kidney donors. Transplant Proc. 2015; 47:290–4.
18. Thukral S, Mazumdar A, Ray DS. Long-Term Consequences of Complex Living Renal Donation: Is It Safe? Transplant Proc. 2018;50: 3185–91.
19. Tavakol MM, Vincenti FG, Assadi H, Frederick MJ, Tomlanovich SJ, Roberts JP, Posselt AM. Long-term renal function and cardiovascular disease risk in obese kidney donors. Clin J Am Soc Nephrol. 2009;4: 1230–8.
20. Kerkeni W, Rebai MH, Bouzouita A, Chakroun M, Slama RB, Abdallah TB et al. The effect of body mass index at the time of donation on postoperative and remote consequences of nephrectomy in 189 Living-related kidney donors. Arab J Urol. 2015;13: 221–4.
21. Quadri S AH, Fulop T, Osman A, Soliman K. Additive Effect of Obesity to Hypertension in Living Donors and Their Impact on Glomerular Filtration Rate Compensation with 5 Year Follow-Up. Am J Transplant. 2020;20
22. Mandelbrot DA, Reese PP, Garg N, Thomas CP, Rodrigue JR, Schinstock C et al. KDOQI US Commentary on the 2017 KDIGO Clinical Practice Guideline on the Evaluation and Care of Living Kidney Donors. Am J Kidney Dis. 2020;75: 299–16.
23. Isbel N CARI guidelines. The CARI guidelines. Donors at risk: obesity. Nephrology (Carlton) 2010;15 Suppl 1:121–32.
24. Oniscu GC, Abramowicz D, Bolignano D, Gandolfini I, Hellemans R, Maggiore U, et al. Management of Obesity in Kidney Transplant Candidates and Recipients: A Clinical Practice Guideline by the DESCARTES Working Group of ERA. Nephrol Dial Transplant (2021) 24(37):1–15.
Published
2024-04-30
How to Cite
TRAJCHESKA, Lada et al. KIDNEY FUNCTION DECLINE AND MORTALITY IN DONORS WITH EXPANDED CRITERIA - FIVE YEARS FOLLOW UP STUDY. Journal of Morphological Sciences, [S.l.], v. 7, n. 1, p. 124-130, apr. 2024. ISSN 2545-4706. Available at: <https://jms.mk/jms/article/view/vol7no1-15>. Date accessed: 20 june 2024.
Section
Articles