Mid- and Long-Term Health Risks in Living Kidney Donors: A Systematic Review and Meta-analysis,Annals of Internal Medicine

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Mid- and Long-Term Health Risks in Living Kidney Donors: A Systematic Review and Meta-analysis
Annals of Internal Medicine ( IF 19.6 ) Pub Date : 2018-01-30 , DOI: 10.7326/m17-1235
Linda M O'Keeffe ₁ , Anna Ramond ₂ , Clare Oliver-Williams ₃ , Peter Willeit ₄ , Ellie Paige ₅ , Patrick Trotter ₆ , Jonathan Evans ₃ , Jonas Wadström ₇ , Michael Nicholson ₆ , Dave Collett ₈ , Emanuele Di Angelantonio ₉

Affiliation

University of Bristol, Bristol, United Kingdom (L.M.O.).
University of Cambridge and National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, Cambridge, United Kingdom (A.R.).
University of Cambridge, Cambridge, United Kingdom (C.O., J.E.).
University of Cambridge, Cambridge, United Kingdom, and Medical University of Innsbruck, Innsbruck, Austria (P.W.).
University of Cambridge, Cambridge, United Kingdom, and Australian National University, Canberra, Australia (E.P.).
National Institute for Health Research Blood and Transplant Research Unit in Organ Donation and Transplantation and University of Cambridge, Cambridge, United Kingdom (P.T., M.N.).
Karolinska University Hospital, Stockholm, Sweden (J.W.).
National Health Service Blood and Transplant, Bristol, United Kingdom (D.C.).
University of Cambridge, National Institute for Health Research Blood and Transplant Research Unit in Donor Health and Genomics, and National Health Service Blood and Transplant, Cambridge, United Kingdom (E.D.).

Background:

Long-term health risks for adults who donate kidneys are unclear.

Purpose:

To summarize evidence about mid- and long-term health risks associated with living kidney donation in adults.

Data Sources:

PubMed, Embase, Scopus, and PsycINFO without language restriction from April 1964 to July 2017.

Study Selection:

Observational studies with at least 1 year of follow-up that compared health outcomes in adult living kidney donors versus nondonor populations.

Data Extraction:

Two investigators independently extracted study data and assessed study quality.

Data Synthesis:

52 studies, comprising 118 426 living kidney donors and 117 656 nondonors, were included. Average follow-up was 1 to 24 years. No evidence suggested higher risk for all-cause mortality, cardiovascular disease, hypertension, type 2 diabetes, or adverse psychosocial health outcomes in living kidney donors than in nondonor populations. Donors had higher diastolic blood pressure, lower estimated glomerular filtration rates, and higher risk for end-stage renal disease (ESRD) (relative risk [RR], 8.83 [95% CI, 1.02 to 20.93]) and preeclampsia in female donors (RR, 2.12 [CI, 1.06 to 4.27]). Despite the increased RR, donors had low absolute risk for ESRD (incidence rate, 0.5 event [CI, 0.1 to 4.9 events] per 1000 person-years) and preeclampsia (incidence rate, 5.9 events [CI, 2.9 to 8.9 events] per 100 pregnancies).

Limitation:

Generalizability was limited by selected control populations, few studies reported pregnancy-related outcomes, and few studies were from low- and middle-income countries.

Conclusion:

Although living kidney donation is associated with higher RRs for ESRD and preeclampsia, the absolute risk for these outcomes remains low. Compared with nondonor populations, living kidney donors have no increased risk for other major chronic diseases, such as type 2 diabetes, or for adverse psychosocial outcomes.

Primary Funding Source:

National Health Service Blood and Transplant and National Institute for Health Research. (PROSPERO: CRD42017072284)

中文翻译：

活肾捐赠者的中长期健康风险：系统评价和荟萃分析

背景：

捐赠肾脏的成年人的长期健康风险尚不清楚。

目的：

总结与成人活体肾脏捐赠相关的中长期健康风险的证据。

数据源：

PubMed、Embase、Scopus 和 PsycINFO，1964 年 4 月至 2017 年 7 月无语言限制。

研究选择：

至少随访 1 年的观察性研究，比较了成人活体肾脏供体与非供体人群的健康结果。

数据提取：

两名研究者独立提取研究数据并评估研究质量。

数据合成：

纳入 52 项研究，包括 118 426 名活体肾脏供体和 117 656 名非供体。平均随访时间为 1 至 24 年。没有证据表明活体肾脏供体的全因死亡率、心血管疾病、高血压、2 型糖尿病或不良心理社会健康结果的风险高于非供体人群。捐献者的舒张压较高，估计肾小球滤过率较低，终末期肾病 (ESRD) 的风险较高（相对风险 [RR]，8.83 [95% CI，1.02 至 20.93]）和女性捐献者的先兆子痫（RR , 2.12 [CI, 1.06 至 4.27])。尽管 RR 增加，但捐献者的 ESRD（发病率，每 1000 人年 0.5 次事件 [CI，0.1 至 4.9 次事件]）和先兆子痫（发病率，每 100 人 5.9 次事件 [CI，2.9 至 8.9 次事件]）的绝对风险较低怀孕）。

局限性：

可推广性受到选定对照人群的限制，很少有研究报告与妊娠相关的结果，也很少有研究来自低收入和中等收入国家。

结论：

尽管活体肾脏捐赠与 ESRD 和先兆子痫的 RR 较高相关，但这些结果的绝对风险仍然很低。与非供体人群相比，活体供肾者患其他主要慢性疾病（如 2 型糖尿病）或不良心理社会后果的风险并未增加。

主要资金来源：

国家卫生服务血液和移植和国家卫生研究所。(PROSPERO: CRD42017072284)

更新日期：2018-01-30

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