Satisfaction With Life Among Living Kidney Donors: A RELIVE Study of Long-Term Donor Outcomes.
Messersmith EE, Gross CR, Beil CA, Gillespie BW, Jacobs C, Taler SJ, Merion RM, Jowsey SG, Leichtman AB, Hong BA, and the RELIVE Study Group. Transplantation. December 27, 2014.
Living kidney donation accounts for a significant proportion of kidney transplants world-wide. It is an extremely safe procedure for the donor, although it continues to have a small but significant morbidity and mortality rate. Recently some doubts have been raised about the long-term outcomes of the donors. There have been several cross-sectional and a few longitudinal studies assessing the quality of life and satisfaction of donors, and the report here from three U.S. transplant centers adds to our knowledge and understanding, providing some insights as to how process could be changed to improve donor satisfaction.
Three U.S. transplant centers mailed questionnaires and 2,455 (71% of the contacted sample) responded. The majority responded they were satisfied with their lives and this satisfaction was associated primarily with their recalled experience of the donation. Other factors such as the positive effect of the donation and social support were also associated with satisfaction. While it is reassuring that the majority responded a good satisfaction score, one in five did not. This was related to financial difficulties and length of recovery but, somewhat surprisingly, not to the recipient’s outcome. The strength of the study is that the authors identified factors that the units can change to help improve the satisfaction, including helping relieve financial pressures within legal and ethical constraints, providing more support later in the recovery process, and understanding the pressures on deciding whether or not to donate. Sure, there are limitations recognized by the authors, but this does provide helpful guidance to improve the process.
The Risk of Cancer in Recipients of Living-Donor, Standard and Expanded Criteria Deceased Donor Kidney Transplants: A Registry Analysis.
Ma MKM, Lim WH, Turner RM, Chapman JR, Craig JC, Wong G. Transplantation. December 27, 2014.
Solid organ transplantation is associated with a risk of de novo and donor transmitted cancer. This is well recognized and potential recipients should be informed that this is a risk that can be reduced but not abolished. In this analysis of the Australian and New Zealand Dialysis and Transplant Registry, Ma and colleagues have assessed the risk of cancer (excluding donor transmitted cancer) in kidney recipients, comparing living, deceased standard, and expanded criteria donors (ECD), and showed that the risks of cancer were greatest in recipients of ECD kidneys, especially for genitourinary and posttransplant lymphoproliferative disease. ECD was defined as donor aged 50 years or more with at least two of hypertension, cerebrovascular cause for brain death, and renal impairment as shown by serum creatinine >133umol/L.
The authors hypothesize that this is related to a viral etiology although there is no clear evidence for this, or that it is related to increased immunosuppression or any other donor factors. Numbers are small (comparatively) so no impact on, for example, Kaposi’s sarcoma could be identified, and the inherent limitations of any analysis of registry data mean that a more detailed analysis could be undertaken to suggest which factors are relevant. The matching of donors and recipients, especially ECD donors, is not random so there may be associations that cannot be detected in the analysis. This study will also remind both clinicians and patients to be vigilant for development of certain cancers.