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Abstract: SA-PO821

Long-Term Outcomes for Living Kidney Donors With Early Guideline-Concordant Follow-Up Care

Session Information

Category: Transplantation

  • 2002 Transplantation: Clinical

Authors

  • Dhalla, Anisha, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Lloyd, Anita, University of Alberta Department of Medicine, Edmonton, Alberta, Canada
  • Lentine, Krista L., Saint Louis University School of Medicine, Saint Louis, Missouri, United States
  • Garg, Amit X., Western University Schulich School of Medicine & Dentistry, London, Ontario, Canada
  • Quinn, Robert R., University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Ravani, Pietro, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
  • Klarenbach, Scott, University of Alberta Department of Medicine, Edmonton, Alberta, Canada
  • Hemmelgarn, Brenda, University of Alberta Department of Medicine, Edmonton, Alberta, Canada
  • Lam, Ngan, University of Calgary Cumming School of Medicine, Calgary, Alberta, Canada
Background

Current guidelines recommend that living kidney donors receive lifelong annual follow-up care. In the United States, the reporting of complete clinical and laboratory data for kidney donors has been mandated for the first two years post-donation to improve adherence with follow-up; however, the long-term impact of early guideline-concordant care remains unclear.

Methods

We conducted a retrospective, population-based cohort study using linked healthcare databases in Alberta, Canada to compare long-term post-donation follow-up care and clinical outcomes of living kidney donors with and without early guideline-concordant care. The primary outcome was receipt of continued follow-up at 5 and 10 years after donation as defined by annual physician visits, serum creatinine, and albuminuria measurements (adjusted odds ratio with lower and upper 95% confidence limits, LCLaORUCL).

Results

Of the 460 donors included in the study, 187 (41%) had clinical and laboratory evidence of guideline-concordant follow-up care throughout the first two years post-donation. The odds of receiving annual follow-up for donors without early guideline-concordant care were 76% lower at 5 years (aOR 0.180.240.32) and 68% lower at 10 years (aOR 0.230.320.46) compared to donors with early care. The odds of continuing follow-up remained stable over time for both groups. Early guideline-concordant follow-up care did not substantially influence estimated glomerular filtration rate (eGFR) or hospitalization rates over the longer term.

Conclusion

Although policies directed towards improving early donor follow-up may encourage continued follow-up, additional strategies may be necessary to mitigate lifetime donor risks.

Proportion of living kidney donors with 3 markers of follow-up care (physician visit, serum creatinine and albuminuria measurement) during each post-donation year stratified by those with and without early guideline-concordant care (EGCC).

Funding

  • Government Support – Non-U.S.