Abstract: TH-PO968

Mortality in Living Kidney Donors with ESRD: A Propensity Score Analysis Using the United States Renal Data System

Session Information

Category: Transplantation

  • 1702 Transplantation: Clinical and Translational

Authors

  • Nee, Robert, Walter Reed National Military Medical Center, Bethesda, Maryland, United States
  • Brar, Amarpali, SUNY Downstate Medical Center, Brooklyn, New York, United States
  • Stefanov, Dimitre, SUNY Downstate Medical Center, Brooklyn, New York, United States
  • Jindal, Rahul M., Uniformed Services University , Bethesda, Maryland, United States
  • Joshi, Madhu Raj, SUNY Downstate Medical Center, Brooklyn, New York, United States
  • Cadet, Bair, SUNY Downstate Medical Center, Brooklyn, New York, United States
  • Salifu, Moro O., SUNY Downstate Medical Center, Brooklyn, New York, United States
Background

Living kidney donation has been performed with the premise of acceptable safety of kidney donors. Although a very small percentage of living donors progress to end-stage renal disease (ESRD) after donor nephrectomy, evidence suggest that the rate of ESRD is comparable to that in the general population. However, for those donors who develop ESRD, their survival on dialysis has not been systematically assessed.

Methods

We used the United States Renal Data System (USRDS), and abstracted 274 prior living kidney donors (cases) between 1995 to 2009. There were 609,398 on dialysis without kidney donation (controls). Univariate analysis was used to test differences between the unmatched groups. We used propensity score matching to identify 258 cases and 258 controls. Time-dependent Cox proportional hazards model, adjusted for demographic factors and comorbidities, was used to compare survival between the two matched cohorts.

Results

In the propensity score-matched cohort, mortality was lower in cases compared with controls (19% vs 49%, p<0.0001). Cox model results demonstrated that cases had significantly lower mortality compared with controls (adjusted hazard ratio [AHR] 0.20, 95% CI 0.14-0.28, p<0.0001). Time-segmented analyses showed cases with significantly lower mortality 0-5 years (AHR 0.15; 95% CI 0.10-0.24; p<0.0001), and 5-10 years since start of dialysis (AHR 0.26; 95% CI 0.14-0.48; p<0.0001). After 10 years, the difference in survival was nonsignificant (AHR 0.48; 95% CI 0.17-1.32; p=0.15), likely due to the small sample size of patients in this time interval.

Conclusion

We observed a lower mortality rate in living donors with ESRD compared to matched non-donors. This data will guide clinicians in the informed consent process with prospective donors.

Survival curves of donors vs. matched non-donors with ESRD