Living kidney donors are susceptible to the same diseases as the general population. Additionally, those with a family history of ESKD may be at increased risk for kidney disease. Long-term studies comparing donors with the general population have not found increased donor risks. However, two studies comparing donors to healthy controls found an increased risk of ESKD, and one of the studies found increased donor mortality (reviewed in O’Keeffe et al.1).
It would be ideal to provide those considering donation with an estimate of their individual long-term risks based on information known at the time of donor evaluation. Two risk calculators, based on long-term donor follow-up have been published.2,3 We developed a calculator for proteinuria and reduced renal function based on long-term follow-up of donors at the University of Minnesota.2 This was published as an Excel spreadsheet in the Supplement to our JASN article on long-term donor outcomes and provided the ability to generate dynamic graphic risks of proteinuria and eGFR decline for kidney donors with varying risk profiles. Subsequently, based on national data, Massie et al.3 developed a risk calculator for 20-year risk of ESKD.
To increase accessibility for patients, physicians, and coordinators, we adapted our risk models into a user-friendly web-based calculator using updated data (three additional years of follow-up) and 419 additional living kidney donors. Additionally, we included updated risk models for hypertension and type 2 diabetes based on our previous publications.4,5 This risk assessment tool provides a comprehensive long-term (40 year) projection of living kidney donor health based on the experience of 4606 kidney donors with a median follow-up time of 22.8 years (minimum = 0.8, maximum = 56.4). The calculator can be found at https://shiny.biostat.umn.edu/Transplant/KidneyDonor/.
Disclosures
A. Matas reports consultancy agreements with Veloxis; research funding with Alexion, Astellas, BMS, CareDX, Shire, and Veloxis; honoraria from Astellas, CareDX, CSL Behring, and Veloxis; and scientific advisor or membership from CSL Behring, Jazz Pharma, and CareDX. S. Vempati is employed by Twilio and has ownership interest in Twilio. All remaining authors have nothing to disclose.
Funding
None.
Footnotes
Published online ahead of print. Publication date available at www.jasn.org.
References
- 1.O’Keeffe LM, Ramond A, Oliver-Williams C, Willeit P, Paige E, Trotter P, et al.: Mid- and long-term health risks in living kidney donors: A systematic review and meta-analysis. Ann Intern Med 168: 276–284, 2018. [DOI] [PubMed] [Google Scholar]
- 2.Ibrahim HN, Foley RN, Reule SA, Spong R, Kukla A, Issa N, et al.: Renal function profile in white kidney donors: The first 4 decades. J Am Soc Nephrol 27: 2885–2893, 2016. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 3.Massie AB, Muzaale AD, Luo X, Chow EKH, Locke JE, Nguyen AQ, et al.: Quantifying postdonation risk of ESRD in living kidney donors. J Am Soc Nephrol 28: 2749–2755, 2017. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 4.Sanchez OA, Ferrara LK, Rein S, Berglund D, Matas AJ, Ibrahim HN: Hypertension after kidney donation: Incidence, predictors, and correlates. Am J Transplant 18: 2534–2543, 2018. [DOI] [PMC free article] [PubMed] [Google Scholar]
- 5.Ibrahim HN, Kukla A, Cordner G, Bailey R, Gillingham K, Matas AJ: Diabetes after kidney donation. Am J Transplant 10: 331–337, 2010. [DOI] [PMC free article] [PubMed] [Google Scholar]