Evaluation of potential kidney donors and outcomes post-donation at Charlotte Maxeke Johannesburg acdemic hospital (1983 - 2015) a
Background Living kidney donation has emerged as a key therapeutic modality for end-stage kidney disease due to the global chronic shortage of renal allografts. However, the potential benefits to the recipient of a living donor kidney must be balanced against donor safety. In demographically diverse populations, there is a paucity of data regarding the living donor evaluation process and outcomes following donation. Objectives This study was undertaken to describe donation patterns, characterise reasons for nondonation and evaluate long-term morbidity and mortality following living kidney donation in the South African context. Methods A retrospective analysis of all Potential Living Donors (PLDs) evaluated at a single centre over a 32-year period was conducted. Of the total cohort of 1208 PLDs, 298 were Accepted Living Donors (ALDs), resulting in 910 Failed Living Donors (FLDs). Data collected included donor demographics. In addition, in the ALD group, clinical and laboratory parameters at various points in donor follow-up, as well as mortality data was noted. In the FLD group reason for donor exclusion was documented. Results Of the 1208 PLDs, 697 (58%) were female. The majority (559; 46%) were of Black African descent, and related to the intended recipient (991; 82%). Outcome of PLD evaluation varied significantly by race (p<0.001), with only a third of Black PLDs being accepted for donation. Black vs. Caucasian PLDs were more likely to fail workup (52.1% vs. 39.3%; p<0.001) and be excluded for medical reasons (44% vs. 35%; p<0.001). Leading medical exclusions included hypertension, HIV and obesity. In the ALD cohort, median follow-up time was 44 months (IQR 13.8 – 93.5 months). Hypertension was documented in 12.8% of ALDs at most recent follow-up compared to 4.7% of ALDs pre-donation (p=0.06). There was a significant increase in Albumin Excretion Rate (AER) following donation (p<0.001). There was a significant decline in the CKD-EPI eGFR between pre-donation (91.7 ± 19.1 ml /min/1.73 m2) and the most recent visit postdonation (72.5 ± 20 ml/min/1.73 m2; p<0.001). 27% of ALDs had a CKD-EPI eGFR<60 ml/min/1.73 m2 at most recent visit, however none required renal replacement therapy. There were 5 documented deaths, all unrelated to the development of renal dysfunction. Black ethnicity was not associated with increased risk of adverse outcome following donation. Conclusions There is a high exclusion rate for PLDs. Black PLDs are more likely to be excluded than Caucasian counterparts due to significant comorbidity. Although limited by high rates of donors lost to follow-up, it is concerning that a quarter of ALDs developed an eGFR<60 ml/min/1.73 m2 at last follow-up, with a significant increase in AER.
A research report submitted to the Faculty of Health Sciences, University of Witwatersrand, Johannesburg, in partial fulfillment of the requirements for the degree of Master of Medicine in the branch of Internal Medicine Johannesburg, 2019