L CHAN 1,2,3, G IRISH G3,4,5, T GOH 2, B ALNASRALLAH 2,6, C DAVIES 3, M SYPEK 3,7,8, P CLAYTON 3,4,5, M COLLINS 2,3,9
1Department of Renal Medicine, Waikato Hospital, Hamilton, New Zealand, 2Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand, 3Australia and New Zealand Dialysis and Transplant Registry (ANZDATA), Adelaide, Australia, 4Department of Medicine, University of Adelaide, Adelaide, Australia, 5Central and Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia, 6Qatif Central Hospital, Eastern Province, Saudi Arabia, 7Department of Nephrology, Royal Melbourne Hospital, Melbourne, Australia, 8Department of Medicine, University of Melbourne, Melbourne, Australia, 9Department of Medicine, University of Auckland, Auckland, New Zealand
Aim: To assess the characteristics of all NZ living kidney donors and those who develop kidney failure.
Background: Historically, studies of living kidney donors have not shown an increased risk of kidney failure compared to healthy non-donors. Recently prognosis-matched studies with longer follow-up show this risk may be underestimated. There have been no studies on the risk of kidney failure in the New Zealand (NZ) live donor population.
Methods: Donors were identified via searches of multiple sources: the NZ Blood Service, the Ministry of Health, hospital records, and the Australia and New Zealand Dialysis and Transplant (ANZDATA) Registry. Data linkage was performed with ANZDATA to identify donors who commenced kidney replacement therapy (KRT) until December 2019. Characteristics of donors and those started on KRT are summarised with descriptive statistics.
Results: There were 1526 living kidney donors from 1965-2018. The mean age at donation was 43 years (SD11), 42% were male, and 66% were related to the recipient. Nine donors (0.6%) developed kidney failure and commenced KRT during follow-up. The mean age at KRT was 57 years (SD11), 67% were male, and 67% were NZ European/Pākehā. Comorbidities included smoking (67%), diabetes (56%), and ischaemic heart disease (33%). The causes of kidney failure were diabetic nephropathy (n=4; 44%), glomerulonephritis (n=4; 44%), and attributed to donation (n=1). The median time to KRT was 23 years (IQR 18-30, range 8-36). Of those who started KRT, five received kidney transplants; 60% were pre-emptive, and 80% were from deceased donors.
Conclusion:There is a low risk of kidney failure in NZ living kidney donors. A better understanding of this risk is needed to help potential donors make informed decisions about donation.
Dr Lai Wan Chan graduated from University of Auckland and completed training in renal medicine in Auckland and Waikato. She has worked as a renal physician at Waikato Hospital since 2018 and has an interest in many aspects of renal medicine including kidney transplantation, live kidney donation, peritoneal dialysis, general nephrology and teaching.
She is currently a member of the Aotearoa New Zealand Working Group of the ANZDATA Registry, and a member of the examining team of the Royal Australasian College of Physicians.