Kidney Week

Abstract: SA-PO977

Sociodemographic Correlates of Mortality after Living Kidney Donation: Informing the Need for Nondonor Controls

Session Information

• Transplantation: Clinical - 3
  October 26, 2024 | Location: Exhibit Hall, Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Transplantation

• 2102 Transplantation: Clinical

Authors

• Lentine, Krista L., Saint Louis Univ., St. Louis, Missouri, United States

Krista L. Lentine, MD, PhD, FASN

• Caliskan, Yasar, Saint Louis Univ., St. Louis, Missouri, United States

Yasar Caliskan, MD

• Waterman, Amy D., Houston Methodist, Houston, Texas, United States

Amy D. Waterman, PhD

• Israni, Ajay K., Hennepin County, Minneapolis, Minnesota, United States

Ajay K. Israni, MD, MS

• Snyder, Jon J., Hennepin County, Minneapolis, Minnesota, United States

Jon J. Snyder, PhD

• Hart, Allyson, Hennepin County, Minneapolis, Minnesota, United States

Allyson Hart, MD, MS

• Fleetwood, Vidya, Saint Louis Univ., St. Louis, Missouri, United States

Vidya Fleetwood, MD

Background

Mandated follow-up of living kidney donors (LKDs) in the U.S. is limited to 2 years postdonation. Recently, an expanded linkage of death records to the national transplant registry was conducted, enabling capture of intermediate-term death events after living donation.

Methods

We examined Scientific Registry of Transplant Recipients (SRTR) data incorporating updated linked national death records to examine the incidence and adjusted correlates of mortality (adjusted hazard ratio, _{95% LCL} aHR _{95% UCL}) after donation, censored at 09/02/23. LKDs were registered in 1987-2023.

Results

Among 179,977 LKDs in the registry, overall mortality at 10 years was <1%. 10-year mortality rose with older donor age, up to 4.9% in donors aged >65 years at donation (vs 0.3% in those who donated at age 18-30; aHR; _11.5 15.9 _21.8). Mortality was lower in women (vs men: 0.6% vs 0.9%; aHR, _0.480.55_0.63 ), and in Hispanic and Asian (vs White) LKDs, but slightly higher in spousal donors. Mortality trended higher in uninsured LKDs, was higher in those not working, and nearly twice as high in smokers (vs nonsmokers: 0.9% vs 0.7%; aHR, _1.571.91_2.31). 10-year death risk did not vary significantly according to hypertension history or predonation eGFR.

Conclusion

Intermediate-term mortality after living kidney donation varies with age, sex, race, relationship, education, employment, and smoking status. While trends are similar to general population patterns, comparison to nondonor controls through mechanisms such as the SRTR Living Donor Collective candidate registry are needed for continuous monitoring of donation-attributable risks. Sociodemographic correlates of mortality in LKDs warrant attention for risk mitigation to support optimal long-term outcomes in all donors.