Background: The frequency and severity of perioperative complications after contemporary live kidney donation are not well-described.

Methods: We integrated national U.S. live donor registry data with administrative records from an academic hospital consortium (98 centers, 2008-2012) to identify predonation comorbidity and perioperative complications captured in diagnostic, procedure and registry sources. Complication severity was graded by Clavien scoring. Correlates (adjusted odds ratio, aOR) of complications were examined with multivariate logistic regression.

Results: Among 14,964 donors, 11.6% were African American (AA) and 72.6% Caucasian; 93.8% of nephrectomies began as laparoscopic, 2.4% as robotic, and 3.7% as open procedures. Overall, 16% of donors experienced any perioperative complication, although the highest severity events affected only 2.5%. Compared with Caucasians, AA donors experienced higher rates of any complication (18.2% vs 15.5%, P=0.005), and those exceeding progressive severity thresholds including Clavien >=4 (3.7% vs 2.2%, P=0.0002) (Figure).

After adjustment for demographic, clinical (including comorbidity diagnoses), procedure and center factors, AA race was associated with increased risk of any complication (aOR 1.26, P=0.001), and Clavien >=2 (aOR 1.39, P=0.0002), Clavien >=3 (aOR 1.56, P<0.0001), and Clavien >=4 (aOR 1.56, P=0.004) events. Other significant correlates of Clavien >=4 events included obesity (aOR 1.55), predonation hematologic (aOR 2.78) and psychiatric (aOR 1.45) conditions, and robotic nephrectomy (aOR 2.07), while annual center volume >50 (aOR 0.45) predicted lower risk.

Conclusions: AA race is independently associated with increased frequency and severity of perioperative complications after live donor nephrectomy. Future work should seek to identify underlying mechanisms and approaches to reducing outcome disparities.

CITATION INFORMATION: Lentine K, Lam N, Axelrod D, Schnitzler M, Garg A, Schold J, Brennan D, Randall H, Segev D. Racial Disparities in Perioperative Complications After Live Kidney Donation. Am J Transplant. 2016;16 (suppl 3).

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