• Yaerim Kim, Mi-Yeon Yu, Kyung Don Yoo, Chang Wook Jeong, Hyeon Hoe Kim, Sang-Il Min, Jongwon Ha, Yunhee Choi, Ah Ryoung Ko, Jae Moon Yun, Sang Min Park, Seung Hee Yang, Dong Ki Kim, Kook-Hwan Oh, Kwon Wook Joo, Curie Ahn, Yon Su Kim, and Hajeong Lee.
• Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea.
• Am. J. Kidney Dis. 2020 Jun 1; 75 (6): 919-925.

Rationale & ObjectiveLiving kidney donors may have a higher risk for death and kidney failure. This study aimed to investigate the long-term mortality experience of living kidney donors compared with members of the general public in Korea who underwent voluntary health examinations.Study DesignCohort study.Setting & ParticipantsWe first calculated standardized mortality ratios for 1,292 Korean living kidney donors who underwent donor nephrectomy between 1982 and 2016 and 72,286 individuals who underwent voluntary health examinations between 1995 and 2016. Next we compared survival between the 1,292 living kidney donors and a subgroup of the health examination population (n=33,805) who had no evident contraindications to living kidney donation at the time of their examinations. Last, a matched comparator group was created from the health examination population without apparent contraindication to donation by matching 4,387 of them to donors (n=1,237) on age, sex, body mass index, estimated glomerular filtration rate, urine dipstick albumin excretion, previously diagnosed hypertension and diabetes, and era.ExposuresDonor nephrectomy.OutcomesAll-cause mortality and other clinical outcomes after kidney donation.Analytical ApproachFirst, standardized mortality ratios were calculated separately for living kidney donors and the health examination population standardized to the general population. Second, we used Cox regression analysis to compare mortality between living kidney donors versus the subgroup of the health examination population without evident donation contraindications. Third, we used Cox regression analysis to compare mortality between living kidney donors and matched comparators from the health examination population without apparent contraindication to donation.ResultsThe living kidney donors and health examination population had excellent survival rates compared with the general population. 52 (4.0%) of 1,292 kidney donors died during a mean follow-up of 12.3±8.1 years and 1,072 (3.2%) of 33,805 in the health examiner subgroup without donation contraindications died during a mean follow-up of 11.4±6.1 years. Donor nephrectomy did not elevate the hazard for mortality after multivariable adjustment in kidney donors and the 33,805 comparators (adjusted HR, 1.01; 95% CI, 0.71-1.44; P=0.9). Moreover, living donors showed a similar mortality rate compared with the group of matched healthy comparators.LimitationsDonors from a single transplantation center. Residual confounding owing to the observational study design.ConclusionsKidney donors experienced long-term rates of death comparable to nondonor comparators with similar health status.Copyright © 2019 National Kidney Foundation, Inc. Published by Elsevier Inc. All rights reserved.

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