A study of over 80,000 American live kidney donors found they were likely to live just as long as people who have two healthy kidneys and that the procedure carries very little medical risk.

You can read about the landmark study by lead author and transplant surgeon Dr Dorry L Segev, from the Johns Hopkins University School of Medicine, Baltimore, Maryland, and colleagues, online in the 10 March issue of JAMA, Journal of the American Medical Association.

The researchers said the findings confirm what many doctors have believed for a long time, as Segev, who is also associate professor of surgery at the Johns Hopkins University School of Medicine, told the media:

“Donating a kidney is safe. Live donors start healthy and it’s the highest priority of the surgeon and the entire transplant community to make sure they stay healthy,” he said, adding that these findings show “we have succeeded”.

“While there are never any guarantees with surgery, donating a kidney is safer than undergoing almost any other operation,” said Segev.

There is a profound shortage of transplant organs in the US, where thousands of patients die every year waiting for a new kidney. There is an increasing reliance on live donors such as family members, friends, and even altruistic donors. Live donor transplants also tend to survive longer than those from cadavers.

For the study, Segev and colleagues examined records in a national registry of over 80,000 live kidney donors registered between the beginning of April 1994 to end of March 2009. It is thought to be the first study to use national data: previously published studies of live donors have used data from individual transplant centers.

The researchers found that over that period of 15 years:

  • There were 25 deaths among 80,347 donors in the first 90 days after undergoing donation surgery.
  • This translated to a risk of surgery mortality of 3.1 per 10,000 cases.
  • This risk was found to be slightly higher (but still very small) in some subgroups where there is typically a higher risk from surgery already, ie men (5.1 deaths per 10,000 cases) and African-Americans (7.6 deaths per 10,000 cases).
  • The risk remained low even as the number of live donor kidney transplants nearly doubled in the US from just over 3,000 in 1994 to nearly 6,000 in 2008.

Segev said these figures show that the risk of dying from kidney donation (3.1 per 10,000) is about one sixth of the risk of dying from having one’s gallbladder removed (18 per 10,000).

And if you compare it to the risk of dying from having a kidney removed because of cancer or another medical reason, the contrast is even greater: for the latter the risk is about 260 per 10,000 cases, nearly 100 times the risk of dying from donating a kidney.

The researchers also compared the data from the kidney donors to a matched cohort of over 9,000 people taken from the third National Health and Nutrition Examination Survey (NHANES III), after excluding any persons who would not qualify for kidney donation.

The authors wrote that this comparison showed that:

“Long term risk of death was no higher for live donors than for age- and comorbidity-matched NHANES III participants for all patients and also stratified by age, sex, and race.”

Segev said the study shows that:

“Whatever happens when people donate kidneys, on average, it doesn’t affect the rest of their lives.”

“That never been shown before in a study of this size and scope,” he added.

The authors also pointed out that over the 15 years of the study much has changed in the live donor kidney transplant procedure: it has moved from being a mostly open-abdomen to a minimally invasive laparoscopic operation that leaves tiny scars and has shorter recovery time.

“Perioperative Mortality and Long-term Survival Following Live Kidney Donation.”
Dorry L. Segev; Abimereki D. Muzaale; Brian S. Caffo; Shruti H. Mehta; Andrew L. Singer; Sarah E. Taranto; Maureen A. McBride; Robert A. Montgomery
JAMA, Published online 10 March 2010; Vol. 303, No. 10, pp 959 – 966.

Source: Johns Hopkins Medicine.

Written by: Catharine Paddock, PhD