Medical Research on Living Donor Surgery
Below are summaries of
medical
research studies covering the risks and complications from living
kidney donation. If you need help understanding the terminology,
click here to open Google,
then type "definition [word]" in the
search box, where [word] is the word or words you'd like to have
defined.
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Matas, A.J., et al., 2003.
This extensive study surveyed 171 transplant centers asking about
morbidity and mortality after living kidney donations from 1999 through
2001. The results cover 10,828 living donor nephrectomies. Generally,
the study found the risk of mortality at 0.03% and the risk of
complications, mostly minor, in less than 10% of donors. Here are more
details on the findings:
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Death: two donors (0.02%)
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Persistent vegetative state: one donor (less than
0.01%)
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Re-operation: 66 donors (0.61%). Causes for
re-operation
included hernia, bleeding, bowel obstruction, and bowel injury.
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Complications not requiring re-operation: 65 donors
(0.60%). These complications included bleeding, rhabdomyolysis, deep
vein thrombosis/pulmonary embolus, pneumothorax, and prolonged ileus.
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Readmission rate: 2.2%. Reasons for readmission
included nausea and vomiting, constipation, diarrhea, and wound
infection.
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Su, Li-Ming, et al., 2004.
This study evaluated trends in morbidity among 381 laparoscopic
nephrectomies at Johns Hopkins between 1995 and 2001. Note that the
study looked only at laparoscopic procedures. The total complication
rate was 16.5%, with about half of those complications being major and
half being minor. Researchers also noted that the laparoscopic
procedure was switched to the open method in 2.1% of the cases. Here
are more statistics from the study:
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Re-operation rate: 1.8%
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Transfusion rate: 3.4%
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Major complications: 7.6%. These complications
included renovascular injuries, bowel injuries, and hematoma.
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Minor complications: 8.9%. These complications
included wound infection, transient neuromuscular injury,
epididymitis/urinary tract infection, orchalgia (chronic pain of the testicles and scrotum), retroperitoneal
hematoma, and splenic capsular laceration.
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Siebels, Michael, et
al., 2003. Researchers in Germany evaluated the risks and
complication of living kidney donation based on the experience of
almost 160 nephrectomies. The donations were made between 1994
and 2001. There were no deaths and 41 (25.6%) complications, with 35
(21.9%) minor and six (3.8%) major.
Minor complications included urinary tract infection (10%), unknown
fever (4.4%), splenic hemorrhages (3.1%), blood transfusion (3.1%), and
pneumonia (2.5%). Major complications included one case each of
splenectomy, liver bleeding, incarcerated umbilical hernia, infected
pancreatic pseudocyst, pneumothorax, and acute renal failure.
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Shaffer, David, et al.,
1998. This older study reviewed the morbidity (but not
mortality) of 201 living-donor kidney transplants between 1988 and 1997:
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Major complications: bleeding (0.5%),
pneumothorax requiring a chest tube (1%), wound infection (1%), and
pneumonia (1%).
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Minor complications: asymptomatic pneumothrorax
resolving itself spontaneously (10%), urinary retention (6%), and
urinary tract infection (0.5%).
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Friedman, Amy, et al.,
2006. The final study looks at a specific form of complication
in living kidney donation--hemorrhaging. The study is based in 213
surveys of transplant surgeons. The respondents reported 105
incidences, of which 66 were arterial and 39 were venous . Of the
arterial episodes, two resulted in donor death, two resulted in renal
failure, and 19 required transfusions. Conversion from laparoscopic
nephrectomy to open nephrectomy or late re-operations for hemorrhage
were reported in 29 cases.
Hemorrhagic complications were found to occur in both open and
laparoscopic procedures, with the use of locking and standard clips
applied to the renal artery being associated with the greatest risks.
Our hope is that research will continue with more
extensive participation and deeper analysis. We believe this kind of
information is necessary for potential living donors to be sufficiently
educated for true "informed consent." LDO will keep a watch out for
additional medical research on this subject as it becomes available.
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