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Mid- and Long-Term Health Risks in Living Kidney Donors: A Systematic Review and Meta-analysis

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Di Angelantonio, Emanuele  ORCID logo
Willeit, Peter 
Oliver-Williams, Clare  ORCID logo
O'Keeffe, Linda 


Background: Long-term health risks for adults who donate kidneys are unclear.

Purpose: To summarize evidence about mid- and long-term health risks associated with living kidney donation in adults.

Data Sources: PubMed, Embase, Scopus, and PsycINFO without language restriction from April 1964 to July 2017.

Study Selection: Observational studies with at least 1 year of follow-up that compared health outcomes in adult living kidney donors versus nondonor populations.

Data Extraction: Two investigators independently extracted study data and assessed study quality.

Data Synthesis: 52 studies, comprising 118 426 living kidney donors and 117 656 nondonors, were included. Average follow-up was 1 to 24 years. No evidence suggested higher risk for all-cause mortality, cardiovascular disease, hypertension, type 2 diabetes, or adverse psychosocial health outcomes in living kidney donors than in nondonor populations. Donors had higher diastolic blood pressure, lower estimated glomerular filtration rates, and higher risk for end-stage renal disease (ESRD) (relative risk [RR], 8.83 [95% CI, 1.02 to 20.93]) and preeclampsia in female donors (RR, 2.12 [CI, 1.06 to 4.27]). Despite the increased RR, donors had low absolute risk for ESRD (incidence rate, 0.5 event [CI, 0.1 to 4.9 events] per 1000 person-years) and preeclampsia (incidence rate, 5.9 events [CI, 2.9 to 8.9 events] per 100 pregnancies).

Limitation: Generalizability was limited by selected control populations, few studies reported pregnancy-related outcomes, and few studies were from low- and middle-income countries.

Conclusion: Although living kidney donation is associated with higher RRs for ESRD and preeclampsia, the absolute risk for these outcomes remains low. Compared with nondonor populations, living kidney donors have no increased risk for other major chronic diseases, such as type 2 diabetes, or for adverse psychosocial outcomes.



32 Biomedical and Clinical Sciences, 3202 Clinical Sciences, Cardiovascular, Hypertension, Prevention, Patient Safety, Kidney Disease, Clinical Research, Renal and urogenital, 3 Good Health and Well Being, Humans, Kidney, Kidney Transplantation, Living Donors, Postoperative Complications, Risk Factors, Tissue and Organ Harvesting

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Annals of Internal Medicine

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American College of Physicians
Medical Research Council (MR/L003120/1)
British Heart Foundation (None)
Dr. Di Angelantonio received grant funding from National Health Service Blood and Transplant. The work of the coordinating center was funded by grant WP12-01 from National Health Service Blood and Transplant and grant NIHR BTRU-2014-10024 from the National Institute for Health Research Blood and Transplant Research Unit.