Comorbidity burden and perioperative complications for living kidney donors in the United States

Abstract

Background and objectives: Since 1998, 35% of kidney transplants in the United States have been derived from living donors. Research suggests minimal long-term health consequences after donation, but comprehensive studies are limited. The primary objective was to evaluate trends in comorbidity burden and complications among living donors.

Design, setting, participants, & measurements: The National Inpatient Sample (NIS) was used to identify donors from 1998 to 2010 (n=69,117). Comorbid conditions, complications, and length of stay during hospitalization were evaluated. Outcomes among cohorts undergoing appendectomies, cholecystectomies and nephrectomy for nonmetastatic carcinoma were compared, and sample characteristics were validated with the Scientific Registry of Transplant Recipients (SRTR). Survey regression models were used to identify risk factors for outcomes.

Results: The NIS captured 89% (69,117 of 77,702) of living donors in the United States. Donor characteristics were relatively concordant with those noted in SRTR (mean age, 40.1 versus 40.3 years [P=0.18]; female donors, 59.0% versus 59.1% [P=0.13]; white donors, 68.4% versus 69.8% [P<0.001] for NIS versus SRTR). Incidence of perioperative complications was 7.9% and decreased from 1998 to 2010 (from 10.1% to 7.6%). Men (adjusted odds ratio [AOR], 1.37; 95% confidence interval [CI], 1.20 to 1.56) and donors with hypertension (AOR, 3.35; 95% CI, 2.24 to 5.01) were more likely to have perioperative complications. Median length of stay declined over time (from 3.7 days to 2.5 days), with longer length of stay associated with obesity, depression, hypertension, and pulmonary disorders. Presence of depression (AOR, 1.08; 95% CI, 1.04 to 1.12), hypothyroidism (AOR, 1.07; 95% CI, 1.04 to 1.11), hypertension (AOR, 1.38; 95% CI, 1.27 to 1.49), and obesity (AOR, 1.07; 95% CI, 1.03 to 1.11) increased over time. Complication rates and length of stay were similar for patients undergoing appendectomies and cholecystectomies but were less than those with nephrectomies for carcinoma.

Conclusions: The NIS is a representative sample of living donors. Complications and length of stay after donation have declined over time, while presence of documented comorbid conditions has increased. Patients undergoing appendectomy and cholecystectomy have similar outcomes during hospitalization. Monitoring the health of living donors remains critically important.

Figure 1.

Proportion of living donors with comorbid conditions listed at discharge by year. Results based on National Inpatient Sample (n=69,117).

Figure 2.

Secular trends in length of stay and procedure-related complications. Results based on National Inpatient Sample data (n=69,117).

Figure 3.

Proportion of patients with procedure-related complications and median length of stay between surgical interventions. Sample sizes for study groups derived from the National Inpatient Sample between 1998 and 2010 are as follows: living-donor nephrectomy, n=69,117; cholecystectomy, n=3,011,628; appendectomy, n=2,262,065; and nephrectomy for carcinoma, n=13,461.

Figure 4.

Change in annual rates of complications and length of stay over time between surgical interventions. Sample sizes for study groups derived from the National Inpatient Sample between 1998 and 2010 are as follows: living-donor nephrectomy, n=69,117; cholecystectomy, n=3,011,628; appendectomy, n=2,262,065; and nephrectomy for carcinoma, n=13,461.