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1.
Poggio ED, Braun WE, Davis C. The science of stewardship: due diligence for kidney donors and kidney function in living kidney donation—evaluation, determinants, and implications for outcomes.  Clin J Am Soc Nephrol. 2009;4(10):1677-168419713294PubMedGoogle ScholarCrossref
2.
Delmonico FL, Dew MA. Living donor kidney transplantation in a global environment.  Kidney Int. 2007;71(7):608-61417290291PubMedGoogle ScholarCrossref
3.
Ibrahim HN, Foley R, Tan L,  et al.  Long-term consequences of kidney donation.  N Engl J Med. 2009;360(5):459-46919179315PubMedGoogle ScholarCrossref
4.
Delmonico F.Council of the Transplantation Society.  A report of the Amsterdam forum on the care of the live kidney donor: data and medical guidelines.  Transplantation. 2005;79(6):(suppl)  S53-S6615785361PubMedGoogle ScholarCrossref
5.
 United Network for Organ Sharing Web site. http://www.unos.org. Accessed February 5, 2010
6.
Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tyden G, Groth CG. Kidney donors live longer.  Transplantation. 1997;64(7):976-9789381544PubMedGoogle ScholarCrossref
7.
Garg AX, Muirhead N, Knoll G,  et al; Donor Nephrectomy Outcomes Research (DONOR) Network.  Proteinuria and reduced kidney function in living kidney donors: a systematic review, meta-analysis, and meta-regression.  Kidney Int. 2006;70(10):1801-181017003822PubMedGoogle ScholarCrossref
8.
Najarian JS, Chavers BM, McHugh LE, Matas AJ. 20 years or more of follow-up of living kidney donors.  Lancet. 1992;340(8823):807-8101357243PubMedGoogle ScholarCrossref
9.
Goldfarb DA, Matin SF, Braun WE,  et al.  Renal outcome 25 years after donor nephrectomy.  J Urol. 2001;166(6):2043-204711696703PubMedGoogle ScholarCrossref
10.
Okamoto M, Akioka K, Nobori S,  et al.  Short- and long-term donor outcomes after kidney donation: analysis of 601 cases over a 35-year period at Japanese single center.  Transplantation. 2009;87(3):419-42319202449PubMedGoogle ScholarCrossref
11.
Andersen B, Hansen JB, Jorgensen SJ. Survival after nephrectomy.  Scand J Urol Nephrol. 1968;2(2):91-945734267PubMedGoogle ScholarCrossref
12.
Friedman AL, Peters TG, Jones KW, Boulware LE, Ratner LE. Fatal and nonfatal hemorrhagic complications of living kidney donation.  Ann Surg. 2006;243(1):126-13016371747PubMedGoogle ScholarCrossref
13.
Johnson EM, Remucal MJ, Gillingham KJ, Dahms RA, Najarian JS, Matas AJ. Complications and risks of living donor nephrectomy.  Transplantation. 1997;64(8):1124-11289355827PubMedGoogle ScholarCrossref
14.
Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999-2001: survey of United States transplant centers.  Am J Transplant. 2003;3(7):830-83412814474PubMedGoogle Scholar
15.
Steiner CA, Bass EB, Talamini MA, Pitt HA, Steinberg EP. Surgical rates and operative mortality for open and laparoscopic cholecystectomy in Maryland.  N Engl J Med. 1994;330(6):403-4088284007PubMedGoogle ScholarCrossref
16.
Birkmeyer JD, Siewers AE, Finlayson EV,  et al.  Hospital volume and surgical mortality in the United States.  N Engl J Med. 2002;346(15):1128-113711948273PubMedGoogle ScholarCrossref
17.
Lucas FL, Stukel TA, Morris AM, Siewers AE, Birkmeyer JD. Race and surgical mortality in the United States.  Ann Surg. 2006;243(2):281-28616432363PubMedGoogle ScholarCrossref
18.
Nathan H, Frederick W, Choti MA, Schulick RD, Pawlik TM. Racial disparity in surgical mortality after major hepatectomy.  J Am Coll Surg. 2008;207(3):312-31918722934PubMedGoogle ScholarCrossref
19.
Sheikh K, Jiang Y, Bullock CM. Effect of comorbid and fatal coexistent conditions on sex and race differences in vascular surgical mortality.  Ann Vasc Surg. 2007;21(4):496-50417628266PubMedGoogle ScholarCrossref
20.
Turrentine FE, Wang H, Simpson VB, Jones RS. Surgical risk factors, morbidity, and mortality in elderly patients.  J Am Coll Surg. 2006;203(6):865-87717116555PubMedGoogle ScholarCrossref
21.
Nguyen GC, Laveist TA, Segev DL, Thuluvath PJ. Race is a predictor of in-hospital mortality after cholecystectomy, especially in those with portal hypertension.  Clin Gastroenterol Hepatol. 2008;6(10):1146-115418928940PubMedGoogle ScholarCrossref
22.
Bay WH, Hebert LA. The living donor in kidney transplantation.  Ann Intern Med. 1987;106(5):719-7273551714PubMedGoogle ScholarCrossref
23.
Schulam PG, Kavoussi LR, Cheriff AD,  et al.  Laparoscopic live donor nephrectomy: the initial 3 cases.  J Urol. 1996;155(6):1857-18598618273PubMedGoogle ScholarCrossref
24.
Ratner LE, Kavoussi LR, Schulam PG, Bender JS, Magnuson TH, Montgomery R. Comparison of laparoscopic live donor nephrectomy versus the standard open approach.  Transplant Proc. 1997;29(1-2):138-1399122930PubMedGoogle ScholarCrossref
Original Contribution
March 10, 2010

Perioperative Mortality and Long-term Survival Following Live Kidney Donation

Author Affiliations

Author Affiliations: Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland (Drs Segev, Muzaale, Singer, and Montgomery); Departments of Epidemiology (Drs Segev, Muzaale, and Mehta) and Biostatistics (Dr Caffo), Johns Hopkins School of Public Health, Baltimore, Maryland; and United Network for Organ Sharing, Richmond, Virginia (Dr McBride and Ms Taranto).

JAMA. 2010;303(10):959-966. doi:10.1001/jama.2010.237
Abstract

Context More than 6000 healthy US individuals every year undergo nephrectomy for the purposes of live donation; however, safety remains in question because longitudinal outcome studies have occurred at single centers with limited generalizability.

Objectives To study national trends in live kidney donor selection and outcome, to estimate short-term operative risk in various strata of live donors, and to compare long-term death rates with a matched cohort of nondonors who are as similar to the donor cohort as possible and as free as possible from contraindications to live donation.

Design, Setting, and Participants Live donors were drawn from a mandated national registry of 80 347 live kidney donors in the United States between April 1, 1994, and March 31, 2009. Median (interquartile range) follow-up was 6.3 (3.2-9.8) years. A matched cohort was drawn from 9364 participants of the third National Health and Nutrition Examination Survey (NHANES III) after excluding those with contraindications to kidney donation.

Main Outcome Measures Surgical mortality and long-term survival.

Results There were 25 deaths within 90 days of live kidney donation during the study period. Surgical mortality from live kidney donation was 3.1 per 10 000 donors (95% confidence interval [CI], 2.0-4.6) and did not change during the last 15 years despite differences in practice and selection. Surgical mortality was higher in men than in women (5.1 vs 1.7 per 10 000 donors; risk ratio [RR], 3.0; 95% CI, 1.3-6.9; P = .007), in black vs white and Hispanic individuals (7.6 vs 2.6 and 2.0 per 10 000 donors; RR, 3.1; 95% CI, 1.3-7.1; P = .01), and in donors with hypertension vs without hypertension (36.7 vs 1.3 per 10 000 donors; RR, 27.4; 95% CI, 5.0-149.5; P < .001). However, long-term risk of death was no higher for live donors than for age- and comorbidity-matched NHANES III participants for all patients and also stratified by age, sex, and race.

Conclusion Among a cohort of live kidney donors compared with a healthy matched cohort, the mortality rate was not significantly increased after a median of 6.3 years.

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