Linda M. O'Keeffe, PhD *; Anna Ramond, DPharm *; Clare Oliver-Williams, PhD; Peter Willeit, MD; Ellie Paige, PhD; Patrick Trotter, MBChB; Jonathan Evans, MBChB; Jonas Wadström, MD; Michael Nicholson, MD; Dave Collett, PhD; Emanuele Di Angelantonio, MD
Disclaimer: The research was funded by the National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics at University of Cambridge. The views expressed are those of the authors and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health.
Financial Support: 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.
Disclosures: Dr. Di Angelantonio reports grants from the National Institute for Health Research and National Health Service Blood and Transplant during the conduct of the study and grants from the U.K. Medical Research Council and British Heart Foundation outside the submitted work. Authors not named here have disclosed no conflicts of interest. Disclosures can also be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M17-1235.
Editors' Disclosures: Christine Laine, MD, MPH, Editor in Chief, reports that she has no financial relationships or interests to disclose. Darren B. Taichman, MD, PhD, Executive Deputy Editor, reports that he has no financial relationships or interests to disclose. Cynthia D. Mulrow, MD, MSc, Senior Deputy Editor, reports that she has no relationships or interests to disclose. Deborah Cotton, MD, MPH, Deputy Editor, reports that she has no financial relationships or interest to disclose. Jaya K. Rao, MD, MHS, Deputy Editor, reports that she has stock holdings/options in Eli Lilly and Pfizer. Sankey V. Williams, MD, Deputy Editor, reports that he has no financial relationships or interests to disclose. Catharine B. Stack, PhD, MS, Deputy Editor for Statistics, reports that she has stock holdings in Pfizer and Johnson & Johnson.
Reproducible Research Statement:Study protocol, statistical code, and data set: Available from Dr. Di Angelantonio (e-mail, firstname.lastname@example.org).
Requests for Single Reprints: Emanuele Di Angelantonio, MD, Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts' Causeways, Cambridge CB1 8RN, United Kingdom; e-mail, email@example.com.
Current Author Addresses: Dr. O'Keeffe: MRC Integrative Epidemiology Unit, School of Social and Community Medicine, Oakfield House, Oakfield Grove, Bristol BS8 2BN, United Kingdom.
Drs. Ramond, Oliver-Williams, and Di Angelantonio and Mr. Evans: Department of Public Health and Primary Care, Strangeways Research Laboratory, Worts' Causeways, Cambridge CB1 8RN, United Kingdom.
Dr. Willeit: Department of Neurology, Medical University of Innsbruck, Christoph-Probst-Platz 1, Innrain 52, A-6020 Innsbruck, Austria.
Dr. Paige: National Centre for Epidemiology and Population Health, Research School of Population Health, The Australian National University, Canberra ACT0200, Australia.
Dr. Trotter and Prof. Nicholson: University of Cambridge Department of Surgery, Box 202, Level E9 Addenbrooke's Hospital, Hills Road, Cambridge CB2 0QQ, United Kingdom.
Dr. Wadström: Department of Transplantation Surgery, Karolinska University Hospital, Huddinge, SE-141 86 Stockholm, Sweden.
Dr. Collett: Statistics and Clinical Audit, NHS Blood and Transplant, Bristol BS34 8RR, United Kingdom.
Author Contributions: Conception and design: L.M. O'Keeffe, A. Ramond, E. Di Angelantonio.
Analysis and interpretation of the data: L.M. O'Keeffe, A. Ramond, C. Oliver-Williams, P. Willeit, P. Trotter, J. Evans, J. Wadström, D. Collett, E. Di Angelantonio.
Drafting of the article: L.M. O'Keeffe, A. Ramond, M. Nicholson, E. Di Angelantonio.
Critical revision of the article for important intellectual content: L.M. O'Keeffe, A. Ramond, C. Oliver-Williams, P. Willeit, E. Paige, P. Trotter, J. Evans, J. Wadström, M. Nicholson, E. Di Angelantonio.
Final approval of the article: L.M. O'Keeffe, A. Ramond, C. Oliver-Williams, P. Willeit, E. Paige, P. Trotter, J. Evans, J. Wadström, M. Nicholson, D. Collett, E. Di Angelantonio.
Statistical expertise: P. Willeit, D. Collett, E. Di Angelantonio.
Obtaining of funding: E. Di Angelantonio.
Administrative, technical, or logistic support: L.M. O'Keeffe, A. Ramond, E. Di Angelantonio, P. Trotter.
Collection and assembly of data: L.M. O'Keeffe, A. Ramond, C. Oliver-Williams, E. Paige.
Long-term health risks for adults who donate kidneys are unclear.
To summarize evidence about mid- and long-term health risks associated with living kidney donation in adults.
PubMed, Embase, Scopus, and PsycINFO without language restriction from April 1964 to July 2017.
Observational studies with at least 1 year of follow-up that compared health outcomes in adult living kidney donors versus nondonor populations.
Two investigators independently extracted study data and assessed study quality.
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).
Generalizability was limited by selected control populations, few studies reported pregnancy-related outcomes, and few studies were from low- and middle-income countries.
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.
National Health Service Blood and Transplant and National Institute for Health Research. (PROSPERO: CRD42017072284)
O'Keeffe LM, Ramond A, Oliver-Williams C, et al. Mid- and Long-Term Health Risks in Living Kidney Donors: A Systematic Review and Meta-analysis. Ann Intern Med. [Epub ahead of print 30 January 2018]168:276–284. doi: 10.7326/M17-1235
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Published: Ann Intern Med. 2018;168(4):276-284.
Published at www.annals.org on 30 January 2018
Nephrology, Renal Replacement Therapy.
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