The impact of the donors' and recipients' medical complications on living kidney donors' mental health

Abstract Background Preoperative characteristics of living kidney donors are commonly considered during donor selection and postoperative follow-up. However, the impact of preoperative uric acid (UA) levels is poorly documented. The aim of this study was to evaluate the association between preoperative serum UA levels and post-donation long-term events and renal function. Methods This was a single-center retrospective analysis of 183 living kidney donors. The donors were divided into high (≥5.5 mg/dl) and low (< 5.5 mg/dl) UA groups. We analyzed the relationship between preoperative UA levels and postoperative estimated glomerular filtration rate (eGFR), as well as adverse events (cardiovascular events and additional prescriptions for hypertension, gout, dyslipidemia, and diabetes mellitus), over 5 years after donation. Results In total, 44 donors experienced 52 adverse events over 5 years. The incidence of adverse events within 5 years was significantly higher in the high UA group than in the low UA group (50% vs. 24%, p = 0.003); this was true even after the exclusion of hyperuricemia-related events (p = 0.047). UA emerged as an independent risk factor for adverse events (p = 0.012). Donors with higher UA levels had lower eGFRs after donation, whereas body mass index, hemoglobin A1c, blood pressure, and low-density lipoprotein cholesterol did not have any impact on the eGFR. Conclusions The findings suggest that preoperative UA levels should be considered during donor selection and postoperative follow-up.

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The Impact of the New Kidney Allocation System on Prior Living Kidney Donors’ Access to Deceased Donor Kidney Transplants: An Early Look

American Journal of Transplantation ◽

10.1111/ajt.14102 ◽

2016 ◽

Vol 17 (4) ◽

pp. 1103-1111 ◽

Cited By ~ 4

Author(s):

J. L. Wainright ◽

A. Y. Kucheryavaya ◽

D. K. Klassen ◽

D. E. Stewart

Keyword(s):

Deceased Donor ◽

Kidney Transplants ◽

Donor Kidney ◽

Kidney Donors ◽

Kidney Allocation ◽

Living Kidney Donors ◽

Allocation System ◽

Deceased Donor Kidney ◽

Kidney Allocation System ◽

The Impact

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Serum Klotho in Living Kidney Donors and Kidney Transplant Recipients: A Meta-Analysis

Journal of Clinical Medicine ◽

10.3390/jcm9061834 ◽

2020 ◽

Vol 9 (6) ◽

pp. 1834 ◽

Cited By ~ 1

Author(s):

Charat Thongprayoon ◽

Javier A. Neyra ◽

Panupong Hansrivijit ◽

Juan Medaura ◽

Napat Leeaphorn ◽

...

Keyword(s):

Cohort Studies ◽

Kidney Transplant ◽

Mean Difference ◽

Kidney Donation ◽

Kidney Transplant Recipients ◽

Lower Serum ◽

Kidney Donors ◽

Living Kidney Donors ◽

Study Results ◽

The Impact

α-Klotho is a known anti-aging protein that exerts diverse physiological effects, including phosphate homeostasis. Klotho expression occurs predominantly in the kidney and is significantly decreased in patients with chronic kidney disease. However, changes in serum klotho levels and impacts of klotho on outcomes among kidney transplant (KTx) recipients and kidney donors remain unclear. A literature search was conducted using MEDLINE, EMBASE, and Cochrane Database from inception through October 2019 to identify studies evaluating serum klotho levels and impacts of klotho on outcomes among KTx recipients and kidney donors. Study results were pooled and analyzed utilizing a random-effects model. Ten cohort studies with a total of 431 KTx recipients and 5 cohort studies with a total of 108 living kidney donors and were identified. After KTx, recipients had a significant increase in serum klotho levels (at 4 to 13 months post-KTx) with a mean difference (MD) of 243.11 pg/mL (three studies; 95% CI 67.41 to 418.81 pg/mL). Although KTx recipients had a lower serum klotho level with a MD of = −234.50 pg/mL (five studies; 95% CI −444.84 to −24.16 pg/mL) compared to healthy unmatched volunteers, one study demonstrated comparable klotho levels between KTx recipients and eGFR-matched controls. Among kidney donors, there was a significant decrease in serum klotho levels post-nephrectomy (day 3 to day 5) with a mean difference (MD) of −232.24 pg/mL (three studies; 95% CI –299.41 to −165.07 pg/mL). At one year following kidney donation, serum klotho levels remained lower than baseline before nephrectomy with a MD of = −110.80 pg/mL (two studies; 95% CI 166.35 to 55.24 pg/mL). Compared to healthy volunteers, living kidney donors had lower serum klotho levels with a MD of = −92.41 pg/mL (two studies; 95% CI −180.53 to −4.29 pg/mL). There is a significant reduction in serum klotho levels after living kidney donation and an increase in serum klotho levels after KTx. Future prospective studies are needed to assess the impact of changes in klotho on clinical outcomes in KTx recipients and living kidney donors.

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