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Availability of cadaveric kidneys is not increasing substantially, so live kidney donation (usually to a relative or close friend) is becoming more common. Researchers used a U.S. national registry to identify more than 80,000 live donors (from 1994 to 2009) and another national registry to identify an equal number of healthy controls (matched for demographic characteristics and comorbidities).
The number of live donors increased over time, from about 3000 to 6000 annually during the study period. Ninety-day postoperative mortality was 3.1 per 10,000 donors (in comparison, 90-day mortality is 18/10,000 for laparoscopic cholecystectomy and 260/10,000 for nondonor nephrectomy) and did not change over time even though average age at donation rose. Postoperative mortality was roughly three times higher in men than in women and in black donors than in white or Latino donors. Long-term mortality was similar in donors and in healthy controls.
Segev DL et al. Perioperative mortality and long-term survival following live kidney donation. JAMA 2010 Mar 10; 303:959.
Comment
Clinicians reasonably can reassure patients who are considering kidney donation that, beyond a small postoperative mortality risk, no excess long-term mortality is evident. The elevated postoperative mortality risk in certain subgroups, although still small compared with that of many surgical procedures, might require more detailed discussions.