Investigators who studied white related living kidney donors (RLKDs) and recipients found that older donors have an increased risk of end-stage kidney disease (ESKD) if the recipient is older at ESKD onset, according to a presentation at the American Transplant Congress 2020 virtual scientific program. Donors’ ESKD risk is not elevated if recipients’ ESKD occurred at a young age.

“Our findings have notable significance for the process of evaluating donors and obtaining their informed consent,” lead investigator Jennifer Wainright, PhD, from the United Network for Organ Sharing, said in a video presentation. “Our results indicate that estimating donor risk of ESKD is more complicated than the results of previous research suggested.”

Dr Wainright and colleagues studied 45,700 white first-degree RLKDs in the United States between 1994 and 2018. Of these, ESKD developed in 115 of them through December 2018.

Investigators followed up donors for a median of 14 years. For the 115 patients, the median time from their donation and ESKD onset was 13.7 years.


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“This study is the first to find evidence of a recipient factor that predicts ESKD in related donors,” Dr Wainright said. “Specifically, we found that older donor age was associated with higher risk if the related recipient first developed ESKD at older age, such as age 55. But being older was not associated with higher risk if the related recipient developed ESKD at a younger age, such as age 20.”

On multivariable analysis, male sex and higher body mass index at donation independently predicted high ESKD risk.

“Despite the advances we have made in the past decade, Dr Wainright said, “our prediction models [for renal disease] are still far from perfect. They don’t provide all the information we want to give prospective donors to help them assess their risk and make the right decision for themselves and their families.”

Reference

Wainright J, Robinson A, Wilk A, et al. Recipient and donor factors associated with post-donation ESRD in related white living kidney donors. Presented at the 2020 virtual American Transplant Congress held May 29 to 31. Abstract 356.