More than 90,000 adults have undergone living donor nephrectomy in the United States over the last 20 years. Live donor kidney transplantation (LDKT) is important because its outcomes for recipients are superior to those of deceased donor transplantation, and it yields significant cost savings to the healthcare system overall. Despite efforts over the past few decades to enhance understanding of the short- and long-term outcomes of living kidney donation, it is clear that we have more knowledge in some areas (e.g., surgical and medical complications) than in others (e.g., psychological outcomes, financial impact). While the transplant community and changes in federal regulations have brought attention to the need for more systematic study of living donor outcomes, there remains a paucity of scientifically rigorous multisite, prospective outcome studies. The long-term goal of our research program is to characterize the short- and long-term surgical, medical, functional, psychological, and financial outcomes of living kidney donation. The objective of this application, which is the next step in pursuit of that goal, is to establish a multisite prospective cohort of living kidney donors (n=240), their recipients (n=240), and a healthy comparison group (n=240). This cohort will be used to examine three primary aims: (1) to assess donor outcomes (surgical, medical, functional, psychological, financial) over a 2-year period initially, with the intention of examining these outcomes over a more extended time period in subsequent years;(2) to identify the donor, recipient, and center variables that are most predictive of donor outcomes;and (3) to identify disparities in donor outcomes and their predictors. To accomplish these aims, six kidney transplant programs, representing six states (Massachusetts, Maine, Rhode Island, Florida, Iowa, and Arizona) and with experience and expertise in caring for living donors and transplant recipients, will participate in the study. Donors, their recipients, and healthy controls will complete comprehensive assessments at baseline (pre-surgery) and at 1, 6, 12, and 24 months post-donation. This study will extend our considerable preliminary work by simultaneously examining outcomes that are of importance to donors, recipients, healthcare providers, and policymakers. The rationale for the proposed research is that, once these outcomes and their predictors are known, we can further develop and refine educational strategies and informed consent processes for both living donors and their intended recipients, as well as provide systematic data to inform policy discussions and clinical care practice.

Public Health Relevance

This study directly addresses several recommendations made by the U.S. Department of Health and Human Services'Advisory Committee on Organ Transplantation. Reliable data on the surgical, medical, functional, psychological, and financial outcomes of living donors will not only guide the design of live donor educational programs, but will have the potential to guide living donation practices and policies.

Agency
National Institute of Health (NIH)
Institute
National Institute of Diabetes and Digestive and Kidney Diseases (NIDDK)
Type
Research Project (R01)
Project #
5R01DK085185-04
Application #
8610916
Study Section
Kidney, Nutrition, Obesity and Diabetes (KNOD)
Program Officer
Narva, Andrew
Project Start
2011-03-10
Project End
2015-02-28
Budget Start
2014-03-01
Budget End
2015-02-28
Support Year
4
Fiscal Year
2014
Total Cost
$638,491
Indirect Cost
$150,114
Name
Beth Israel Deaconess Medical Center
Department
Type
DUNS #
071723621
City
Boston
State
MA
Country
United States
Zip Code
02215
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Opelami, Oluwaseun; Sakhuja, Ankit; Liu, Xiaobo et al. (2014) Outcomes of infected cardiovascular implantable devices in dialysis patients. Am J Nephrol 40:280-7
Schold, Jesse D; Goldfarb, David A; Buccini, Laura D et al. (2014) Hospitalizations following living donor nephrectomy in the United States. Clin J Am Soc Nephrol 9:355-65
Niemi, Matthew; Mandelbrot, Didier A (2014) The Outcomes of Living Kidney Donation from Medically Complex Donors: Implications for the Donor and the Recipient. Curr Transplant Rep 1:1-9
Rodrigue, James R; Fleishman, Aaron; Vishnevsky, Tanya et al. (2014) Development and validation of a questionnaire to assess fear of kidney failure following living donation. Transpl Int 27:570-5
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Rodrigue, James R; Schold, Jesse D; Mandelbrot, Didier A (2013) The decline in living kidney donation in the United States: random variation or cause for concern? Transplantation 96:767-73
Schold, Jesse D; Goldfarb, David A; Buccini, Laura D et al. (2013) Comorbidity burden and perioperative complications for living kidney donors in the United States. Clin J Am Soc Nephrol 8:1773-82
Schold, J D; Buccini, L D; Heaphy, E L G et al. (2013) The prognostic value of kidney transplant center report cards. Am J Transplant 13:1703-12

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