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. 2022 Apr 18;22(7):1737–1753. doi: 10.1111/ajt.17017

TABLE 2.

Findings of included studies

Study Post‐donation outcomes Risk perspective b Findings
2010, Friedman Perioperative complications Descriptive Comparative: within donors

Adjusted OR for all complications after nephrectomy, in Hispanic donors compared to White donors:

0.97 (95% CI 0.75–1.25)

2010,

Lentine a

CKD

CVD

DM

HTN

 Descriptive Comparative: within‐donor. Comparison of Hispanic versus White individuals, and general population using NHANES 2005–2006

Adjusted HR, at 5 yrs post‐donation, of:

  • CKD in Hispanic donors compared to White donors (medical claims): 1.90 (95% CI 1.05–3.43). In NHANES data, adjusted HR of patient‐reported CKD in Hispanic respondents compared to White respondents: 1.42 (95% CI 0.88–2.27)

  • CVD in Hispanic donors compared to White donors (medical claims): 0.91 (95% CI 0.37–2.26). In NHANES data, adjusted HR of patient‐reported CVD in Hispanic respondents to White respondents: 1.04 (95% CI 0.71–1.52)

  • DM in Hispanic donors compared to White donors from medical claims: 1.65 (95% CI 1.00–2.74), and drug‐treated: 2.94 (95% CI 1.57–5.51). In NHANES data, adjusted HR of patient‐reported DM in Hispanic respondents compared to White respondents: 2.34 (95% CI 1.76–3.12)

  • HTN in Hispanic donors compared to White donors from medical claims: 1.36 (95% CI 1.04–1.78), and drug‐treated: 1.03 (95% CI 0.73–1.46). In NHANES data, adjusted HR of patient‐reported HTN in Hispanic respondents compared to White respondents: 0.65 (95% CI 0.51–0.83)

Estimated prevalence of HTN among Hispanic living donors 5 yrs after nephrectomy, as compared to the general Hispanic population, according to subgroup:

Female sex evaluated at age 40: 18.4 (95% CI 13.4–23.1) in Hispanic donors; 10.4 (95% CI 8.5–12.7) in Hispanic NHANES respondents

Male sex, evaluated at age 40: 20.6 (95% CI 14.9–25.8) in Hispanic donors; 9.8 (95% CI 7.9–12.0) in Hispanic NHANES respondents

Female sex evaluated at age 55: 40.2 (95% CI 30.5–48.6) in Hispanic donors; 21.6 (95% CI 18.1–25.6) in Hispanic NHANES respondents

Male sex, evaluated at age 55: 44.2 (95% CI 33.3–53.3) in Hispanic donors; 20.5 (95% CI 16.9–24.5) in Hispanic NHANES respondents

Estimated prevalence of DM among Hispanic living donors 5 yrs after nephrectomy, as compared to the general Hispanic population, according to subgroup:

Female sex evaluated at age 40: 5.7 (95% CI 2.6–8.7) in Hispanic donors; 7.5 (95% CI 6.0–9.3) in Hispanic NHANES respondents

Male sex, evaluated at age 40: 5.2 (95% CI 2.3–8.1) in Hispanic donors; 7.2 (95% CI 5.6–9.3) in Hispanic NHANES respondents

Female sex evaluated at age 55: 10.8 (95% CI 4.8–16.4) in Hispanic donors; 14.5 (95% CI 11.8–17.7) in Hispanic NHANES respondents

Male sex, evaluated at age 55: 9.9 (95% CI 4.2–15.4) in Hispanic donors; 14.5 (95% CI 11.8–17.7) in Hispanic NHANES respondents
2010, Segev Mortality Descriptive Comparative, within‐donor

  • Surgical 90‐Day mortality: 2.0 deaths per 10 000 donors (95% CI 0.2–7.3) among Hispanic donors compared to White donors 2.6 (95% CI 1.4–4.2)

  • 12‐month mortality: 6.1 deaths per 10 000 donors (95% CI 2.2–13.3) among Hispanic donors compared to White donors 5.5 deaths per 10 000 donors (95% CI 3.7–7.7)

  • No significant difference in 12‐month mortality between White, Black, and Hispanic donors (p = .08).

  • 12‐year mortality: Adjusted HR 1.0 (95% CI 0.3–3.2) for Hispanic donors compared to White donors
2011, Lentine a

DM

HTN

Accounting for relatedness

 Descriptive Comparative, within‐donor

Adjusted HR, at 5 yrs post‐donation, of developing DM or HTN among Hispanic donors related to recipients compared to White donors similarly related to recipients:

  • DM from Type 1 Diabetic recipient: 0.98 (95% CI 0.12–8.33)

  • DM from Type 2 Diabetic recipient: 3.14 (95% CI 0.83–11.86)

  • HTN from recipient with ESKD from HTN: 0.64 (95% CI 0.23–1.82)

2014,

Lentine

Am J Nephrol a

HTN Descriptive Comparative, within‐donor

Adjusted HR, at 5 yrs post‐donation, likelihood of pharmacy fills for Hispanic compared to White donors:

  • Any anti‐hypertensive medication: 1.02 (95% CI 0.74–1.40)

  • Diuretic: 1.07 (95% CI 0.68–1.70)

  • ACEi/ARB: 1.18 (95% CI 0.77–1.81)

  • CCB: 0.82 (95% CI 0.40–1.68)

  • BB: 0.74 (95% CI 0.40–1.37)

  • Vasodilator/other: 0.36 (95% CI 0.05–2.66)

2014, Lentine

Transp.

CKD

DM

HTN

 Descriptive Comparative, within‐donor

Adjusted HR, at 5 yrs post‐donation, among Hispanic donors with Medicare compared to White donors with Medicare of developing:

  • Any HTN: 1.17 (95% CI 0.95–1.46)

  • Benign HTN: 1.11 (95% CI 0.84–1.46)

  • Malignant HTN: 1.96 (95% CI 1.04–3.69)

  • Unspecified HTN: 1.36 (95% CI 1.08–1.70)

  • Any DM: 2.11 (95% CI 1.54–2.89)

  • Type 1 DM: 0.95 (95% CI 0.29–3.09)

  • Type 2 DM: 2.13 (95% CI 1.56–2.92)

  • CKD: 1.13 (95% CI 0.75–1.70)

  • Proteinuria: 0.98 (95% CI 0.40–2.44)
2014, Muzaale ESKD Descriptive Comparative, within‐donor; Attributable: LKD versus healthy non‐donors

Cumulative Incidence of ESKD at 15 yrs per 10 000, among Hispanic donors: 32.6 (95% CI 17.9–59.1), compared to White donors: 22.7 (95% CI 15.6–30.1)

Cumulative Incidence of ESKD at 15 yrs for Hispanic donors: 32.6 per 10 000 (95% CI 17.9–59.1), compared to healthy Hispanic non‐donors: 6.7 per 10 000 (95% CI 0.00–15.0), for an absolute risk increase of ESKD at 15 yrs of 25.9 per

10 000 (p = .002)
2014, Schold Rehospitalization Descriptive Comparative, within‐donor

Cumulative Incidence of:

  • All‐cause rehospitalization following initial discharge in Hispanic donors at 1 year:7%, 3 yrs: 19%, compared to White donors at 1 year: 5%, 3 yrs: 11%

  • Non‐pregnancy related rehospitalizations following initial discharge in Hispanic donors at 1 year: 6%, at 3 yrs: 13%, compared to White donors at 1 year: 5%, 3 yrs: 9%

Adjusted HR in Hispanic donors compared to White donors:

  • All‐cause rehospitalizations following initial discharge: 1.28 (95% CI 1.02–1.61)

  • Non‐pregnancy related: 1.29 (95% CI 0.97–1.70)

2015,

Lam a

Gout Descriptive Comparative within‐donor Adjusted HR, at 7 yrs post‐donation, among Hispanic donors compared to White donors of developing gout (diagnostic billing claim or pharmacy fill), 0.60 (95% CI 0.19–1.9); gout diagnosis alone: 0.72 (95% CI not reported, p‐value >0.05); starting gout medication alone: 1.05 (CI not reported, p‐value >0.05)

2015,

Lentine a

Proteinuria

Nephrotic Syndrome

Nephritis/ Nephropathy

Renal Failure

Any kidney diagnosis

CKD

Accounting for relatedness

 Descriptive Comparative, within‐donor

Adjusted HR, at 7 yrs post‐donation, among Hispanic donors compared to White donors for:

  • Proteinuria 1.47 (95% CI 0.67–3.26)

  • Nephrotic syndrome 5.61 (95% CI 0.49–64.30)

  • Nephritis/nephropathy 0.70 (95% CI, 0.09–5.33)

  • Renal failure, unspecified 0.44 (95% CI 0.06–3.23)

  • Any kidney diagnosis 1.31 (95% CI 0.82–2.09)

  • CKD 1.90 (95% CI 1.05–3.43)

Adjusted HR (including adjustment for donor‐recipient relationship), at 7 yrs post‐donation, for Hispanic donors compared to White donors for:

  • Proteinuria: 1.45 (95% CI 0.66–3.21)

  • Nephrotic syndrome: 5.46 (95% CI 0.48–62.57)

  • Nephritis/nephropathy: 0.69 (95% CI 0.09–5.30)

  • Renal failure unspecified: 0.44 (95% CI, 0.06–3.28)

  • Any renal diagnosis: 1.32 (95% CI 0.83–2.11)

  • Disorders of impaired renal function: 1.07 (95% CI 0.65–1.78)

  • CKD: 1.91 (95% CI 1.06–3.44)

2016,

Anjum

ESKD, early (0–9 yrs) & late (10–25 yrs) post‐ donation:

DM‐related

HTN‐related

GN‐ related

 Descriptive Comparative, within‐donor

IRR of late post‐donation (10–25 yrs) ESKD compared with early post donation ESKD (0–9 yrs) in Hispanic donors compared to White donors:

  • DM‐related: 0.8 (95% CI 0.2–3.4)

  • HTN‐related: 2.1 (95% CI 1.0–4.1)

  • GN‐related: 0.8 (95% CI 0.2–2.6)
2016, Lentine

Perioperative

Complications

 Descriptive Comparative, within donors

  • Adjusted OR (95% CI) of perioperative complications in Hispanic donors compared to White donors: Any complication: 1.01 (0.86–1.18); Clavien grade II or higher 1.04 (0.85–1.27); Clavien grade III or higher 1.20 (0.98–1.48); Clavien grade IV or higher 1.69 (1.24–2.31)

  • Adjusted OR (95% CI) of risk of perioperative complication in Hispanic compared to White donors: Genitourinary: 0.74 (0.45–1.23); Vascular 0.59 (0.23‐: 1.48); Bleeding 1.25 (0.86–1.82); Thrombosis 0.36 (0.11–1.15), Wound 0.71 (0.34–1.48); Hernia 0.71 (0.34–1.48); Injury 0.92 (0.53–1.63); 0.65 (0.40–1.05); Cardiac 1.53 (0.79–2.95), Respiratory 1.08 (0.72–1.61), Gastrointestinal 0.80 (0.57–1.13); Other types 0.84 (0.60–1.19)
2017, Massie ESKD Descriptive Comparative, within‐donor Adjusted HR of ESKD within Hispanic donors compared to White donors 1.16 (95% CI 0.75–1.80; p = .5)
2018, Wainright ESKD Descriptive Comparative, within‐donor

  • Cumulative Incidence at 20 yrs post‐donation: 40.7 events per 10 000 Hispanic compared to White donors: 38.0 events per 10 000

  • Adjusted HR, at 20 yrs post‐donation, of ESKD in Hispanic donors compared to White donors: 1.29 (95% CI 0.8–2.07; p‐value 0.291)

  • Adjusted HR of ESKD, per 10‐year increase in age, among Hispanic donors: 1.18 (95% CI 0.81–1.73)

  • Cumulative incidence of ESKD in LKD by income quartile: Among Hispanic donors, those residing in neighborhoods in the lowest income quartile did not have a greater risk of ESKD among donors from poorer neighborhoods (graphical depiction only)
2019, Holscher

Early, w/in 2 yrs post‐donation:

DM

HTN

 Descriptive Comparative, within‐donor

Adjusted IRR for risk among Hispanic versus non‐Hispanic donors:

  • DM: 2.45 (95% CI 1.14–5.26)

  • HTN: 0.71 (95% CI 0.55–0.93)

2019,

Lentine,

 Anti‐DM med use, Non‐insulin anti‐DM med use, Insulin use Descriptive Comparative, within‐donor

Adjusted HR, at 9 yrs post‐donation, among Hispanic donors compared to White donors of:

  • Taking any anti‐diabetic medication (ADM) 1.29 (95% CI 0.95–1.77)

  • Use of non‐insulin ADM 1.27 (95% CI 0.92–1.75)

  • Insulin use 2.91 (95% CI 1.05–8.12)

2020,

Muzaale

 ESKD, stratified by biological relatedness Descriptive Comparative, within Hispanic donor only

  • For Hispanic donors, the 20‐year post‐donation risk (cumulative Incidence) for ESKD per 10 000 donors: 35 (95% CI 19–64) for full siblings, 35 (95% CI 12–100) for offspring, 39 (95% CI 17–91) for parents, 52 (95% CI 17–165), for half‐sibling/other biologic relatives, 22 (95% CI 6–79) for biologically unrelated donors

  • Adjusted OR, at 20‐year post‐donation, of ESKD among Hispanic donors, compared with unrelated Hispanic donors: was undefined for identical twins, 1.4‐fold (95% CI 0.6–3.3) for full siblings, 1.5‐fold (95% CI 0.5–3.8) for offspring, 1.5‐fold (95% CI 0.6–3.7) for parents, 1.0‐fold (95% CI 0.3–3.7) for half‐siblings or other biologic relatives.

  • Adjusted HR, at 20‐year post‐donation, of ESKD among Hispanic donors, compared with unrelated Hispanic donors: was undefined for identical twins, 1.7‐fold (95% CI 0.5–6.4) for full siblings, 2.2‐fold (95% CI 0.5–9.5) for offspring, 1.6‐fold (95% CI 0.4–11.7) for parents, 2.3‐fold (95% CI 0.4–11.7) for half‐siblings or other relatives.

2021,

Augustine

 Change in eGFR, Proteinuria Descriptive Comparative, within‐donor

  • Estimated mean of 2‐year % change in eGFR for Hispanic donors: 28.4, compared to White donors: 29.9. p‐value reported as <0.05

  • OR of proteinuria at any time point during the 2‐year follow‐up (n = 28 727) for Hispanic compared to White donors: 1.54 (95% CI 1.39–1.71)

Abbreviations: ACEi, ace inhibitor; ADM, anti‐diabetic medication; Am J Nephrol, American Journal of Nephrology; ARB, angiotensin receptor blocker; BB, beta blocker; CCB, calcium channel blocker; CI, confidence interval; CKD, chronic kidney disease; CVD, cardiovascular disease; DM, diabetes mellitus; ESKD, end‐stage kidney disease; GN, glomerulonephritis; HR, hazard ratio; HTN, hypertension; NHANES, National Health and Nutrition Examination Survey; OR, odds ratio; Transp, Transplantation; yrs, years.

a

Same cohort (original study: Lentine et al., 2010).

b

Perspective of risk among Hispanic living kidney donors, as previously described in Lentine et al. 24