Thirty-Year Trends in Perioperative Mortality Risk for Living Kidney Donors

[Clark]

https://jamanetwork.com/journals/jama/fullarticle/2822922
Thirty-Year Trends in Perioperative Mortality Risk for Living Kidney Donors   Allan B. Massie, et al.
JAMA
2024;332;(12):1015-1017. doi:10.1001/jama.2024.14527


Living kidney donor candidates must be accurately informed of the risks of perioperative mortality. The best current estimate, 3.1 deaths within 90 days per 10 000 donations, comes from a study of donors from 1994 to 2009.1 Open donor nephrectomy, standard of care in the 1990s, has now been replaced almost completely by laparoscopic nephrectomy.2,3 Because of this transition, as well as improvements in donor selection, perioperative care, and surgical technique,4 prior estimates of perioperative mortality may not accurately represent current risk to donors. We performed a national registry study to characterize temporal trends in perioperative mortality in donors and risk factors associated with this event.
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Discussion
Perioperative mortality after living donation declined substantially in the past decade compared with prior decades, to fewer than 1 event per 10 000 donations. Risk was higher for male donors and donors with a history of hypertension. Current guidelines5 for donor informed consent, based on 2009 data, should be updated to reflect this information.
Study limitations include that with only 36 perioperative deaths in 30 years, power to estimate relative risks is limited. Additionally, follow-up may be incomplete. However, OPTN requirements for donor follow-up have grown stricter, with 6-month follow-up required for donors since 2013; as such, missingness would bias toward lower mortality in earlier eras, the opposite of what the study found.