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Living Kidney Donors, Cardiovascular Mortality, & Lifespan

From 1963-2007, there were a total of 2269 living kidney donors in Norway with a mean age of 47.6 +/- 12.6 years at the time of donation (41.3% male). Median observation time: 14.3 years.

324 LDs died during study period, but the cause of death was only available for the first 274 because the database was updated only to Jan 1, 2008.

 

The practice [of living kidney donation] is based on the assumption that carefully selected donors, being offered qualified medical follow-up*, are not exposed to future medical risks. 

*In Norway, LKDs are given lifelong medical care, unlike the US where uninsured people are accepted as living donors and left to fend for themselves (See more here)

And then they admit:

However, data supporting this view is rather scarce and hampered with methodological problems. 

 

It’s well-established that a modest drop in renal function results in an increase in proteinuria and blood pressure, causing a greater risk of cardiovascular disease and death in the general population. So, this study (and others like it) are attempting to discern if the same phenomenon exists in living kidney donors when we know LKDs also experience an increase in proteinuria and blood pressure after nephrectomy.

 

However, life expectancy following kidney donation has been described as similar or superior to that of the general background population. Such studies do not take into account that kidney donors are extremely health and clearly supposed to have a substantially longer life with less medical complications than the general population. (emphasis mine)

The Ibrahim study from 2009 still continues to cause great furor because it claimed (or rather, the media coverage claimed) that LKDs live just as long, if not longer than, the general population. The study is rife with flaws, the least of which is that it was single center, mostly white, and only covered six-plus years, but our authors here tackled the major problem with all the versus-gen-pop papers that have appeared as of late:

The control group is not accurately matched to the living kidney donor population.

 

While the national media ran wild with the Ibrahim press release, no one followed up with the equally important, but more far pendantic and less glamorous, criticism levied by Lin et al:

For a comparison group, the investigators used rates of death in the general population, which included adults with coexisting medical conditions (e.g., heart and kidney disease) that would make them ineligible for kidney donation.

 

Lin et al. carved out a cohort that much more closely resembles that of living kidney donors, which Mjoen used in his comparison. The mortality rate between the two was fairly even from age 20-59, but at age 60, living kidney donors began dying in larger numbers, a rate that increased even more for folks over the age of 70.

LKDs 60-69:

22.07 +/- 2.45 deaths per 1000

vs. Gen Pop:

17.02 +/- 3.72

 

LKDs 70-79:

44.32 +/- 6.53

vs. Gen Pop:

27.83 +/- 5.01

 

Now refer back to that ‘substantially longer life’ thing.

Just last night a living donor cheerleader (she donated to a stranger and is involved with a group run by a kidney recipient whose sole purpose is to convince other people to donate kidneys to strangers) poo-poo-ed the fact that Ron Herrick died in his 70s, on dialysis and after cardiac surgery.

“He lived fifty-some odd years” she said.

 

Right. But everything in his demographics indicate he should’ve lived a helluva lot longer. And if you subscribe to the notion forwarded by Heeman, that one of the goals of the ethical acceptability of living kidney donation is to ensure that both the kidney donor and the recipient live a life free of dialysis, then Ron Herrick is not a success story**.

These details are important because (well, obviously) people die at the end of their lives. Studying living kidney donors when they’re 45 or 60 says nothing about life expectancy if their deaths don’t occur until they’re 75. We can’t know if living kidney donation reduces one’s lifespan if we don’t compare how long an ‘extremely healthy’ person should should live with how long they actually do.

Admittedly, even if we had this data, some people would be willing to trade (insert number here) years of their own life to keep their loved one around. And that’s okay, if someone is making a personal and informed choice. But right now, we’re not even making educated guesses. Some transplant centers, meanwhile, are handing prospective LKDs copies of Ibrahim (or Segev) and insisting that donating a kidney has no affect on longevity at all. This sort of manipulation disguised as education is making the decision for the donor, and that’s not ethically acceptable at all.

 

 

 

**Mjoen found six previous kidney donors with kidney disease as the primary diagnosis on the death certificate (five chronic renal failure, one glomerulonephritis) and nine of the controls (six chronic renal failure, one glomerulonephritis and two hypertensive kidney disease). They acknowledged this was statistically “slightly more frequent among kidney donors”.

 

Mjoen, G., Reisaeter, A., Hallan, S., Line, P., Hartmann, A., Midtvedt, K., Foss, A., Dahle, D., & Holdaas, H. (2011). Overall and cardiovascular mortality in Norwegian kidney donors compared to the background population Nephrology Dialysis Transplantation, 27 (1), 443-447 DOI: 10.1093/ndt/gfr303

Permanent link to this article: http://livingdonorsarepeopletoo.com/living-kidney-donors-and-cardiovascular-mortality-one-more-time/

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