ITS 2012 Report – Live donor kidney transplantation: Intestinal transplant activity and outcome

by Maria Dalby – Donating a kidney in later life can have a positive effect on quality of life, according to the largest study to date on this subject. A team of transplant clinicians at the Erasmus Medical Centre in Rotterdam showed that individuals over 60 years of age who donated a kidney recovered quickly from the operation and enjoyed excellent physical quality of life in the post-operative phase. The results of the study were presented by Dr Karel Klop.

Advances in surgical techniques in recent years have improved the outcomes after nephrectomy to a point where both elderly and obese patients can become living organ donors without any significant risk of severe complications. Increasing the pool of elderly donors can help to meet the demand for kidneys for transplantation, especially as the number of elderly patients on the waiting list continues to go up in most countries.

To assess the impact of organ donation on quality of life of elderly donors compared with younger donors in a prospective controlled fashion, Dr Klop and colleagues added completion of health-related quality of life questionnaires to a total of three studies with live donors at the Erasmus centre in Rotterdam. During the period from May 2001 to October 2010, a total of 501 live donors completed the SF-36 questionnaire preoperatively and at 1, 3, 6 and 12 months postoperatively. Of these, 135 donors were aged over 60 years (mean age 66 years, versus 45 years in the younger group). The groups were similar in terms of gender, BMI, surgical technique used, postoperative complication rate, and length of stay in the hospital. The elderly donors had a higher rate of minor co-morbidity, as shown by fewer ASA-I scores, and were more likely to be genetically unrelated to the recipient.

At baseline, the SF-36 showed that the donors overall had higher quality of life than the Dutch population in general, with the exception of the “mental health” component. At one month post-donation, the elderly group showed a significant advantage in quality of life in the “bodily pain” (estimated difference vs the younger group 7 points, p=0.001), “role physical” (estimated difference 18 points, p<0.001) and “vitality” (5 points, p=0.008) dimensions. These favourable results were sustained at three months in “bodily pain” (3 points, p=0.04) and “role physical” (8 points, p=0.02). At six and 12 months post-donation, the “physical function” component scores favoured the younger group (estimated difference vs the elderly group 3 and 5 points respectively, p=0.04 and p<0.001). Somewhat to the team’s surprise, donors in the elderly group returned to their baseline faster than the younger group in nearly all dimensions. Dr Klop suggested that the findings of this study could be used to encourage elderly people to become living kidney donors as this is likely to have a positive impact on their physical health-related quality of life.

Karel Klop, Erasmus Medical Centre, Rotterdam, the Netherlands