Causes and timing of end-stage renal disease after living kidney donation

Am J Transplant. 2018 May;18(5):1140-1150. doi: 10.1111/ajt.14671. Epub 2018 Mar 1.


End-stage renal disease (ESRD) is a risk after kidney donation. We sought, in a large cohort of kidney donors, to determine the causes of donor ESRD, the interval from donation to ESRD, the role of the donor/recipient relationship, and the trajectory of the estimated GFR (eGFR) from donation to ESRD. From 1/1/1963 thru 12/31/2015, 4030 individuals underwent living donor nephrectomy at our center, as well as ascertainment of ESRD status. Of these, 39 developed ESRD (mean age ± standard deviation [SD] at ESRD, 62.4 ± 14.1 years; mean interval between donation and ESRD, 27.1 ± 9.8 years). Donors developing ESRD were more likely to be male, as well as smokers, and younger at donation, and to have donated to a first-degree relative. Of donors with a known cause of ESRD (n = 25), 48% was due to diabetes and/or hypertension; only 2 from a disease that would have affected 1 kidney (cancer). Of those 25 with an ascertainable ESRD cause, 4 shared a similar etiology of ESRD with their recipient. Almost universally, thechange of eGFR over time was stable, until new-onset disease (kidney or systemic). Knowledge of factors contributing to ESRD after living kidney donation can improve donor selection and counseling, as well as long-term postdonation care.

Keywords: clinical research/practice; donor follow-up; donor nephrectomy; donors and donation; glomerular filtration rate (GFR); health services and outcomes research; hypertension/antihypertensives; kidney (native) function/dysfunction; kidney transplantation/nephrology.

Publication types

  • Clinical Trial

MeSH terms

  • Adult
  • Female
  • Follow-Up Studies
  • Humans
  • Incidence
  • Kidney Failure, Chronic / epidemiology*
  • Kidney Failure, Chronic / etiology
  • Kidney Transplantation*
  • Living Donors / supply & distribution*
  • Male
  • Nephrectomy / adverse effects*
  • Prognosis
  • Risk Factors
  • Tissue and Organ Procurement / methods*
  • United States / epidemiology