RATIONALE & OBJECTIVE Living 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 DESIGN Cohort study. SETTING & PARTICIPANTS We 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. EXPOSURES Donor nephrectomy. OUTCOMES All-cause mortality and other clinical outcomes after kidney donation. ANALYTICAL APPROACH First, 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. RESULTS The 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. LIMITATIONS Donors from a single transplantation center. Residual confounding owing to the observational study design. CONCLUSIONS Kidney donors experienced long-term rates of death comparable to nondonor comparators with similar health status.

中文翻译：

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在韩国生活的肾脏捐助者中的长期死亡率风险。

理由和目的活体肾脏捐献者可能有更高的死亡和肾衰竭风险。这项研究旨在调查活体肾脏捐献者与接受自愿健康检查的韩国普通民众相比的长期死亡率经验。研究设计队列研究。背景和参与者我们首先计算了1982年至2016年间接受捐献者肾切除术的1,292名韩国活体肾脏捐献者以及1995年至2016年之间接受自愿健康检查的72,286个人的标准化死亡率。接下来，我们比较了1,292位活体肾脏捐献者和一个健康检查人群（n = 33,805），他们在检查时对活体肾脏捐赠没有明显的禁忌症。最后的，从健康检查人群中创建了一个匹配的比较者组，没有明显的禁忌症，方法是将他们中的4,387人与年龄，性别，体重指数，估计的肾小球滤过率，尿液试纸白蛋白排泄，先前诊断为高血压的捐献者相匹配（n = 1,237）和糖尿病，以及时代。暴露肾供体切除术。结果肾捐赠后的全因死亡率和其他临床结果。分析方法首先，分别为活体肾脏供体和健康检查人群分别计算标准化死亡率，然后将其标准化为普通人群。其次，我们使用Cox回归分析来比较没有明显捐赠禁忌症的活体肾脏供体与健康检查人群亚组之间的死亡率。第三，我们使用Cox回归分析比较了活体肾脏供体和健康检查人群中相匹配的比较者之间的死亡率，而没有明显的禁忌症。结果与一般人群相比，活体肾脏捐献者和健康检查人群的存活率极高。1,292名肾脏捐献者中有52名（4.0％）在平均随访12.3±8.1年内死亡，健康检查者亚组中无捐赠禁忌症的33,805名中的1,072名（3.2％）在平均随访11.4±6.1年期间死亡。在肾脏供体和33,805个对照者进行多变量调整后，供体肾切除术并未提高死亡率的危险（校正后HR，1.01； 95％CI，0.71-1.44； P = 0.9）。此外，与匹配的健康对照者相比，活体捐献者的死亡率相似。局限性来自单个移植中心的捐赠者。由于观察性研究设计而产生的残留混淆。结论肾脏供体的长期死亡率可与具有相似健康状况的非供体比较者相媲美。