Hot topics in kidney transplantation by Dr. Dorry Segev – Paradigm 1: Risk associated with donation

Topic that is going to be discussed is paradigm shift in living kidney donation. The risk of ESRD in donors is no higher than that of the general population. If a healthy person has one healthy kidney versus two healthy kidneys, is there a risk? As per the new paradigm is yes, there is a risk. If you have proper comparison group, there is attributable risk to the donor but we can estimate this risk and we can make more informed decisions accordingly. It was in 2014, they finally had enough data to compare donors with healthy non donors, for the decades after their donation, we used US registry which had 100 thousand living donors.

Not surprisingly, living donors have a higher risk of ESRD than healthy non-donors, they have one kidney not two kidneys, Infact, risk is 8 times higher risk of getting kidney disease. We know that this risk on average is 0.3% but it varies by patient/donor characteristics. Attributable risk is the extra risk from donating which also varies from patient characteristics. For some people, extra risk is relatively small and some it is high. In obese person with single kidney has very high risk. To estimate the baseline risk, using the data from CKD prognosis consortium which covers about 10 million patients across the globe in various degrees of CKD, we can estimate progression to ESRD, which they did in collaboration with KDIGO as well. Now there is calculator where in you enter the information and it will tell you about baseline risk. These have been incorporated in KDIGO guidelines and first KDIGO guidelines did not take a system-by-system approach but highlighted to look at the patient as a whole.