Journal article
Perioperative Complications After Living Kidney Donation: A National Study
American journal of transplantation, Vol.16(6), pp.1848-1857
06/01/2016
DOI: 10.1111/ajt.13687
PMID: 26700551
Abstract
We integrated the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012) to identify predonation 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 kidney donors, 11.6% were African American. Nephrectomies were predominantly laparoscopic (93.8%); 2.4% were robotic and 3.7% were 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 Classification of Surgical Complications grade IV or higher affected 2.5% of donors. 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 of Clavien grade II or higher (aOR 1.39, p = 0.0002), grade III or higher (aOR 1.56, p < 0.0001), and grade IV or higher (aOR 1.56, p = 0.004) events. Other significant correlates of Clavien grade IV or higher events included obesity (aOR 1.55, p = 0.0005), predonation 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.
Details
- Title: Subtitle
- Perioperative Complications After Living Kidney Donation: A National Study
- Creators
- K. L. Lentine - Saint Louis UniversityN. N. Lam - University of AlbertaD. Axelrod - Dartmouth–Hitchcock Medical CenterM. A. Schnitzler - Saint Louis UniversityA. X. Garg - Western UniversityH. Xiao - Saint Louis UniversityN. Dzebisashvili - Dartmouth–Hitchcock Medical CenterJ. D. Schold - Department of Quantitative Health Sciences; Cleveland Clinic; Cleveland OHD. C. Brennan - Washington University in St. LouisH. Randall - Saint Louis UniversityE. A. King - Johns Hopkins UniversityD. L. Segev - Johns Hopkins University
- Resource Type
- Journal article
- Publication Details
- American journal of transplantation, Vol.16(6), pp.1848-1857
- Publisher
- Wiley
- DOI
- 10.1111/ajt.13687
- PMID
- 26700551
- ISSN
- 1600-6135
- eISSN
- 1600-6143
- Number of pages
- 10
- Grant note
- R01DK096008 / NATIONAL INSTITUTE OF DIABETES AND DIGESTIVE AND KIDNEY DISEASES; United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) Dr. Adam Linton Chair in Kidney Health Analytics R01-DK096008; K24-DK101828 / National Institutes of Health (NIH)/National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK); United States Department of Health & Human Services; National Institutes of Health (NIH) - USA; NIH National Institute of Diabetes & Digestive & Kidney Diseases (NIDDK) KRES-CENT
- Language
- English
- Date published
- 06/01/2016
- Academic Unit
- Surgery
- Record Identifier
- 9984322934702771
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