Long-Term Outcomes for Living Kidney Donors with Early Guideline-Concordant Follow-Up Care

A. Dhalla¹, A. Lloyd², K. L. Lentine³, A. X. Garg⁴, R. R. Quinn¹, P. Ravani¹, S. W. Klarenbach², B. R. Hemmelgarn², U. Ibelo¹, N. N. Lam¹

¹Department of Medicine, Division of Nephrology, University of Calgary, Calgary, AB, Canada, ²Department of Medicine, Division of Nephrology, University of Alberta, Edmonton, AB, Canada, ³Center for Abdominal Transplantation, Saint Louis University, St. Louis, MO, ⁴Department of Medicine, Division of Nephrology, Western University, London, ON, Canada

Meeting: 2022 American Transplant Congress

Abstract number: 102

Keywords: Donation, Glomerular filtration rate (GFR), Monitoring

Topic: Clinical Science » Kidney » 39 - Kidney Living Donor: Long Term Outcomes

Session Information

Session Name: Kidney Living Donor: Long Term Outcomes

Session Type: Rapid Fire Oral Abstract

Date: Sunday, June 5, 2022

Session Time: 5:30pm-7:00pm

Presentation Time: 6:40pm-6:50pm

Location: Hynes Room 206

*Purpose: Current guidelines recommend that living kidney donors receive annual lifelong follow-up to monitor kidney health. It is unclear whether early guideline-concordant care is associated with improved subsequent follow-up and clinical outcomes.

*Methods: We conducted a retrospective, population-based cohort study using linked healthcare databases in Alberta, Canada to study follow-up care and outcomes of living kidney donors who underwent nephrectomy between 2002 and 2013. We compared donors with and without early guideline-concordant care, defined as annual physician visit, serum creatinine, and albuminuria measurement for the first two years post-donation. The primary outcome was evidence of continued annual follow-up at 5 and 10 years (adjusted odds ratio with lower and upper confidence limits, _LCLaOR_UCL). Secondary outcomes included mean change in estimated glomerular filtration rate over time (_LCLeGFR_UCL) and rates of all-cause hospitalization (adjusted rate ratio, _LCLaRR_UCL).

*Results: Our study included 460 living kidney donors, of whom 187 (41%) had early guideline-concordant care. Over a median follow-up period of 10.7 years, the odds of having annual follow-up for donors without early guideline-concordant care were 76% lower at 5 years (aOR _0.180.24_0.32) and 68% lower at 10 years (aOR _0.230.32_0.46) compared to donors with early care. The odds of continuing follow-up remained stable over time for both groups. From 2.5 years post-donation onwards, the eGFR increased slightly over time for donors with early follow-up care (_0.090.34_0.58 mL/min/1.73m² per year) and without early follow-up care (_-0.030.20_0.42 mL/min/1.73m² per year), although the latter was not statistically significant. Hospitalization rates were similar between the two groups (aRR _0.771.19_1.84).

*Conclusions: Early guideline-concordant follow-up care is associated with improved subsequent follow-up but does not have a meaningful impact on eGFR or hospitalization rates. Therefore, mandating early follow-up could serve as a useful policy to encourage continued follow-up, but may not sufficiently mitigate long-term risks.

To cite this abstract in AMA style:

Dhalla A, Lloyd A, Lentine KL, Garg AX, Quinn RR, Ravani P, Klarenbach SW, Hemmelgarn BR, Ibelo U, Lam NN. Long-Term Outcomes for Living Kidney Donors with Early Guideline-Concordant Follow-Up Care [abstract]. Am J Transplant. 2022; 22 (suppl 3). https://atcmeetingabstracts.com/abstract/long-term-outcomes-for-living-kidney-donors-with-early-guideline-concordant-follow-up-care/. Accessed November 21, 2024.

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