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Author Topic: Perioperative Complications after Living Kidney Donation: A National Study  (Read 46458 times)

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Offline Clark

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Original Article
Perioperative Complications after Living Kidney Donation: A National Study
Krista L. Lentine, Ngan N. Lam, David Axelrod, Mark A. Schnitzler, Amit X. Garg, Huiling Xiao, Nino Dzebisashvili, Jesse D. Schold, Daniel C. Brennan, Henry Randall, Elizabeth A. King, and Dorry L. Segev
DOI: 10.1111/ajt.13687
American Journal of Transplantation
Accepted Article (Accepted, unedited articles published online and citable. The final edited and typeset version of record will appear in future.)

We integrated the United States transplant registry with administrative records from an academic hospital consortium (97 centers, 2008–2012) to identify pre-donation comorbidity and perioperative complications captured in diagnostic, procedure, and registry sources. Correlates (adjusted odds ratio, aOR) of perioperative complications were examined with multivariate logistic regression. Among 14,964 living donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% planned open procedures. Overall, 16.8% of donors experienced a perioperative complication, most commonly gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), surgical/anesthesia-related injuries (2.4%), and ‘other’ complications (6.6%). Major Clavien ≥4 complications affected 2.5%. After adjustment for demographic, clinical (including comorbidities), procedure, and center factors, African Americans had increased risk of any complication (aOR=1.26,p=0.001), and Clavien ≥2 (aOR=1.39,p=0.0002), Clavien ≥3 (aOR=1.56,p<0.0001), and Clavien ≥4 (aOR=1.56,p=0.004) events. Other significant correlates of Clavien ≥4 events included obesity (aOR=1.55,p=0.0005), pre-donation hematologic (aOR=2.78,p=0.0002) and psychiatric (aOR=1.45,p=0.04) conditions, and robotic nephrectomy (aOR=2.07,p=0.002), while annual center volume >50 (aOR=0.55,p<0.0001) was associated with lower risk. Complications after live donor nephrectomy vary with baseline demographic, clinical, procedure and center factors, but the most serious complications are infrequent. Future work should examine underlying mechanisms and approaches to minimizing the risk of perioperative complications in all donors.
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