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Saudi Journal of Kidney Diseases and Transplantation
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Year : 2016  |  Volume : 27  |  Issue : 3  |  Page : 563-568
Characteristics and outcome of living kidney donors after donation: A report from Cote d'Ivoire

1 Service of Nephrology, Dialysis and Hypertension, Yopougon Teaching Hospital, Abidjan, Côte d'Ivoire, Côte d'Ivoire
2 Laboratory of National Blood Transfusion Center, Abidjan, Côte d'Ivoire, Côte d'Ivoire

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Date of Web Publication13-May-2016


Kidney transplantation from living kidney donors (LKDs) because of its good results represents a good option for the treatment of patients with the end-stage renal disease. Kidney donation is a relatively safe procedure according to several studies. We conducted this cross-sectional study in order to describe the demographic, clinical, and renal outcome of LKD in Cτte d'Ivoire. From March to November 2014, LKD residing in Cτte d'Ivoire at the time of investigation and having donated the kidney more than one year ago were considered for the study. They were evaluated through a questionnaire. Of the 29 LKD listed in Cτte d'Ivoire, only 14 responded to the questionnaire. The mean age at donation was 43.29 ± 9.12 years (27-59) and 10 of the LKD were women. Eight were related to the recipients, and the remaining were spouses. Laparoscopic nephrectomy was performed in nine LKD. The left kidney was harvested in ten cases. The main motivation for donation in all donors was the desire to save a life. At the time of the survey, the average duration after the donation was 4.57 ± 2.56 years (1-8). Only five donors had a regular nephrological follow-up. Hypertension was observed in one donor, seven had significant proteinuria, and six had glomerular filtration rate <60 mL/min but >30 mL/min. Significantly higher proteinuria was noted in donors under 45 years as compared to those over 45 years (0.43 ± 0.17 g/24 h vs. 0.22 ± 0.03 g/24 h, P = 0.01). Our study suggests that renal disease in LKD in Cτte d'Ivoire is low after a mean follow-up period of four years. A donor registry is essential to ensure better follow-up of donors in order to detect potential adverse effects of kidney donation in the medium as well as in the long-term.

How to cite this article:
Lagou DA, Ackoundou-N'guessan KC, Njapom TL, Sekongo YM, Guei CM, Tia MW, Gnionsahe DA. Characteristics and outcome of living kidney donors after donation: A report from Cote d'Ivoire. Saudi J Kidney Dis Transpl 2016;27:563-8

How to cite this URL:
Lagou DA, Ackoundou-N'guessan KC, Njapom TL, Sekongo YM, Guei CM, Tia MW, Gnionsahe DA. Characteristics and outcome of living kidney donors after donation: A report from Cote d'Ivoire. Saudi J Kidney Dis Transpl [serial online] 2016 [cited 2019 Oct 14];27:563-8. Available from: http://www.sjkdt.org/text.asp?2016/27/3/563/182400

   Introduction Top

Kidney transplantation is the optimal treat- ment of end-stage renal disease. It improves the quality of life and increases the life expec- tancy of these patients. Kidney transplantation from living kidney donors (LKDs) gives the best results in terms of recipient and graft survival in comparison with kidney transplan- tation from cadaveric donor.[1],[2]

In the setting of renal transplantation from LKD, all publications prove indisputably, out- side the risk of perioperative mortality that amounts to 0.02% according to recent data,[3]the absence of significant adverse effects in the medium and long-term.[4],[5]The long-term survival of LKD, who were selected for their good health, is similar to,[4]or greater[6]than the general population of the same age and sex, with identical causes of death. Their quality of life also seems broadly similar to[7]or even better[4]than that of the general population.

In Cτte d'Ivoire, before the implementation of the law authorizing organ donation in 2012, patients were transplanted abroad. The success of a transplantation program depends on many factors, particularly the appropriate selection of donors and the efficient caring of the donors postoperatively. Such good management is likely to favor kidney donation, thereby gua- ranteeing the survival of the program. One of the methods to appropriately look after the kidney donors is their regular follow-up through the use of a donor registry. In a view of encouraging establishment of such a Regis- try, we performed the present study to describe the sociodemographic, clinical characteristics, and the fate of LKD in Cτte d'Ivoire.

   Patients and Methods Top

This was a cross-sectional study conducted from March to November 2014 in the Nephro- logy Service at the University Hospital of Yopougon in Abidjan. It focused on LKD residing in Cτte d'Ivoire at the time of the survey. Living donors who donated the kidney more than one year ago and gave their written consent were included in the study. They answered a questionnaire which comprised the following items: age at time of donation, the time of the survey, gender, marital status, reli- gion, intellectual level, occupation, relation- ship with the recipient, ABO blood group, the kidney removed, the surgical procedure (lapa- roscopic or open surgery), motivations for donation, complications at the sampling point, the psycho-affective impact of the donation, the relationship between donor and recipient, likelihood to re-donate if it were possible, the likelihood to encourage donation, history of hypertension, proteinuria, and renal failure since donation. After answering the question- naire, they were submitted to a clinical exa- mination; blood pressure (BP) and weight were collected. The BP was taken after 5 min rest on three separate occasions, and the ave- rage value of the two last visits was consi- dered. Hypertension was defined according to WHO criteria as BP ≥140/90 mm Hg or in patients already on treatment with anti- hypertensive drugs. Laboratory investigations were also performed, 24 h proteinuria was measured. Proteinuria was considered signi- ficant when its value was ≥300 mg/24 h. Serum creatinine also was determined and the glomerular filtration rate (GFR) was calculated using the chronic kidney disease epidemiology (CKD) formula:[8]

GFR = 141 × minimum [serum creatinine (μmol/L)/K, 1][a]× maximum [serum creatinine (μmol/L) /K, 1]−1,209× 0.993Age× 1.018 (if sex = female). K: 62 for the female and 80 for the male; a = −0.329 for the female and −0.411 for the male. Min indicates the minimum of serum crιatinine/K or 1. Max indicates the maximum of serum crιatinine/K or 1. Renal failure was considered present when GFR was <60 mL/min.

   Statistical Analysis Top

Donors characteristics were described using mean values ± standard deviations of frequen- cies (%). Clinical and biological characteristics were compared between subjects according to their age and the length of time elapsed after donation using the Chi-square test or Fisher exact test for categorical parameters and the Student's t-test or the Mann-Whitney U-test for continuous parameters. A P <0.05 was considered to be significant.

   Results Top

General data of living kidney donor at the time of donation

Of the 29 LKD identified in Cτte d'Ivoire, 14 were included in the study. Kidneys were harvested between June 2006 and May 2013. The mean age at donation was 43.29 ± 9.12 years (27-59). Four donors were over 50 years. A female predominance was noted with a sex ratio of 0.4. Eight LKD were blood relatives of the recipients, one was a second degree relative, and the other six were spouses. Eleven LKD were Christians. Nearly, all (n = 13) the LKD were educated and were em- ployed. Kidney transplantation took place abroad in 11 cases. The kidney removal was by laparoscopy in nine cases, and the left kid- ney was taken from 10 LKD [Table 1].
Table 1. Data of living kidney donors at the time of donation

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The main motivation of the donors for dona- tion was the desire to save a life.

Characteristics of the living kidney donor at the time of the survey

The average duration after kidney donation at the time of the study was 4.57 ± 2.56 years (1-8) and the mean age of the donors was 47.93 ± 10.54 years (31-65).

Three LKD reported residual pain at the sam- pling point level. Twelve LKD expressed their motivation to a new gift of life and encourage- ment of a third person to kidney donation [Table 2]. Half of the LKD reported a good relationship with their recipient after donation. However, three cases of deterioration of rela- tions were noted including a divorce between the recipient and donor [Table 3].
Table 2. Characteristics of living kidney donors during the investigation

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Table 3. Characteristics of the relationship between donors and recipients after donation

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Only five LKD had a regular nephrological follow-up after donation. Hypertension was found in a patient already being treated at the time of the survey. It was noted five years after donation. Significant proteinuria with an average of 0.46 ± 0.18 g/24 h (0.31-0.84) was noted in seven LKD. Six LKD had a GFR <60 mL/min but >30 mL/min with an average of 53.12 ± 3.94 mL/min (48.24-58.14) [Table 2].

The mean values of clinical (BP) and bio- logical parameters (24 h proteinuria, serum creatinine, and GFR) of all of the 14 LKD are shown in [Table 4]. The mean systolic BP (mm Hg) was 121.36 ± 10.58 (11-150) and the diastolic was 79 ± 8.24 (70-100). The mean 24 h proteinuria, serum creatinine, and GFR were, respectively, 0.35 ± 0.17 g/24 h (0.17-0.84), 103.04 ± 21.24 µmol/L (53.1-132.75), and 75.09 ± 26.22 mL/min (48.24-125.49).
Table 4. The mean values of blood pressure and biological parameters of all 14 living kidney donors after

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The comparison of mean BP, 24 h proteinuria, and GFR according to age at donation and du- ration after donation show that there were no significant differences with the clinico-biolo- gical parameters outside a significantly higher proteinuria in LKD under 45 years compared to LKD more than 45 years (P = 0.01) [Table 5].
Table 5. Comparison of mean blood pressure, proteinuria, glomerular filtration rate according to age at
donation and duration after donation of the gift

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   Discussion Top

Kidney transplantation from LKD, due to its good results, represents a treatment of great quality for patients with ESRD. A kidney transplantation program is currently underway in Cτte d'Ivoire. It started three years ago. Before the beginning of our program, kidney transplantation was performed abroad, mainly in Northern African countries and in India.

Sociodemographic characteristics of our do- nors are broadly similar to those reported by other studies.[7],[9],[10]Most of the harvested kid- neys were performed through laparoscopy. This technique, although recent compared to open nephrectomy, is currently increasingly chosen by kidney centers[11]because it is less invasive and allows better postoperative com- fort to the donors.

The main motivation of our donors was the desire to save a life. For spouses, it may be an act of love and above all a way to safeguard the future of the couple. Indeed the words "love" and "presence of children" were regu- larly quoted by spouses to explain their gesture toward their husbands. This, according to Kessler,[12]highlights the mutual benefit the couple can draw from transplantation. Accor- ding to studies,[7],[12]kidney donation does not compromise the psychological future of living donors. It could be a positive experience for the latter with a strengthening of self-esteem. The studies generally pointed out the excellent relationship between donors and recipients. That was also found in most of our donors. Conversely, it should be stressed like Brianηon et al[7]of the possible relationship difficulties that can occur between recipients and donors after donation. We identified three cases in the present study with marital discord after trans- plantation. Hence, a specific psychological therapy after donation can be recommended. Moreover, depression has been described in some LKD.[13]

At the time of the survey, only five donors had regular nephrology consultation. In France,[7]60% of the donors were followed by a nephrologist. Monitoring of living donors after donation is among the recommendations of the British association of transplantation with an annual assessment lifelong, including BP mea- surement and measurement of plasma crea- tinine and proteinuria.[14]

Potential risks for LKD are controversial. The risk of serious complications after dona- tion is extremely low, but not zero according to the literature. In our study, hypertension was found in a donor and occurred five years after donation. He was aged 48 years at the time of donation, with morbid obesity and family history of hypertension. The prevalence of hypertension ranged from 7.6-38% in various studies,[4],[5],[9],[13],[15],[16]and was comparable to that of the general population of the same age.[15]The risk of developing hypertension increases with age and being overweight[4],[15]and is also related to the presence of a family history and diabetes.[17]

Half of our donors had significant protei- nuria, but the levels were not too high (<1 g/day). In Tunisia,[9]the prevalence of protei- nuria (> 300 mg/day) in LKD was 7.4%. Fehrman-Ekholm et al[15]found significant pro- teinuria >1 g/24 h in 3% of LKD. Proteinuria was associated with hypertension and reduc- tion of GFR. Moreover, in the study of Ibrahim et al,[4]the age at donation was asso- ciated with the development of albuminuria. In our study, proteinuria was significantly higher in LKD aged <45 years at the time of dona- tion. Of the eight donors under 45 years, five were overweight.

Incipient renal impairment (GFR <60 mL/min with an average of 53.12 ± 3.94 mL/min) was found in six of our donors. The main published studies[5],[15]report a lower risk of kidney failure among LKD and little difference from the risk in the general population. After the initial decline related to the nephrectomy, the renal function does not decline with time[15],[18]in the absence of risk factors for CKD, outside the age-related deterioration as with any person with two kidneys. The risk of incipient renal disease is around 15%, correlated with age at donation and body mass index.[4]

Although none of our donors developed ESRD, this risk is not zero according to the literature. Rare cases of ESRD have been reported by some authors.[9],[16],[19]The incidence varied from 0.4% to 1.23% according to these studies; varying etiologies occurred and were not different from those reported in the general population.[4],[19]This risk is estimated at less than that of the general population[4]although a recent study showed the opposite with a risk of 11.38 times higher compared to the general population after a median follow-up of 15 years.[20]

   Conclusion Top

With a median time of four years after dona- tion, renal morbidity in our living donors is low. But it should be ensured that a nephro- logist monitors the donors after donation to detect potential adverse effects in the medium and long-term. The creation of an LKD registry is necessary for regular monitoring of the donors in order to better assess their medical future on a long-term basis. Because of the possible occurrence of difficult relationship between donors and recipients, as found in some of our subjects, psychological support after donation must be made mandatory.

Conflict of Interest

The authors declare that they have no con- flicts of interest relevant to the manuscript

   References Top

Hourmant M, Kolko A. Transplantation from a living related donor: Results. Nephrol Ther 2008;4:72-6.  Back to cited text no. 1
Matas AJ, Payne WD, Sutherland DE, et al. 2,500 living donor kidney transplants: A single-center experience. Ann Surg 2001;234: 149-64.  Back to cited text no. 2
Matas AJ, Bartlett ST, Leichtman AB, Delmonico FL. Morbidity and mortality after living kidney donation, 1999-2001: Survey of United States transplant centers. Am J Transplant 2003;3:830-4.  Back to cited text no. 3
Ibrahim HN, Foley R, Tan L, et al. Long-term consequences of kidney donation. N Engl J Med 2009;360:459-69.  Back to cited text no. 4
Najarian JS, Chavers BM, McHugh LE, Matas AJ. 20 years or more of follow-up of living kidney donors. Lancet 1992;340:807-10.  Back to cited text no. 5
Fehrman-Ekholm I, Elinder CG, Stenbeck M, Tydén G, Groth CG. Kidney donors live longer. Transplantation 1997;64:976-8.  Back to cited text no. 6
Briançon S, Germain L, Baudelot C, Bannay A, Virion JM, Thuong M. Quality of life of living kidney donor: A national report. Nephrol Ther 2011;7 Suppl 1:S1-39.  Back to cited text no. 7
Pugliese G, Solini A, Bonora E, et al. The Chronic Kidney Disease Epidemiology Colla- boration (CKD-EPI) equation provides a better definition of cardiovascular burden associated with CKD than the Modification of Diet in Renal Disease (MDRD) Study formula in subjects with type 2 diabetes. Atherosclerosis 2011;218:194-9.  Back to cited text no. 8
Cherif M, Ounissi M, Karoui C, et al. Short- and long-term outcomes of living donors in Tunisia: A retrospective study. Transplant Proc 2010;42:4311-3.  Back to cited text no. 9
Hajji S, Cheddadi K, Medkouri G, et al. Profile of living related kidney donors: A single center experience. Saudi J Kidney Dis Transpl 2010;21:967-70.  Back to cited text no. 10
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Blanco G. Living donor kidney transplantation. Nephrol Ther 2007;3(Suppl 4):S276-81.  Back to cited text no. 11
Kessler M. Psychological aspects of living- donor renal transplantation. Nephrol Ther 2008;4:52-4.  Back to cited text no. 12
Azar SA, Nakhjavani MR, Tarzamni MK, Faragi A, Bahloli A, Badroghli N. Is living kidney donation really safe? Transplant Proc 2007;39:822-3.  Back to cited text no. 13
Brook NR, Nicholson ML. An audit over 2 years' practice of open and laparoscopic live- donor nephrectomy at renal transplant centres in the UK and Ireland. BJU Int 2004;93:1027- 31.  Back to cited text no. 14
Fehrman-Ekholm I, Dunér F, Brink B, Tydén G, Elinder CG. No evidence of accelerated loss of kidney function in living kidney donors: Results from a cross-sectional follow-up. Transplantation 2001;72:444-9.  Back to cited text no. 15
Tsai SF, Shu KH, Ho HC, et al. Long-term outcomes of living kidney donors over the past 28 years in a single center in Taiwan. Transplant Proc 2012;44:39-42.  Back to cited text no. 16
Torres VE, Offord KP, Anderson CF, et al. Blood pressure determinants in living-related renal allograft donors and their recipients. Kidney Int 1987;31:1383-90.  Back to cited text no. 17
Nagib AM, Refaie AF, Hendy YA, et al. Long term prospective assessment of living kidney donors: Single center experience. ISRN Nephrol 2014;2014:502414.  Back to cited text no. 18
Wafa EW, Refaie AF, Abbas TM, et al. End- stage renal disease among living-kidney donors: Single-center experience. Exp Clin Transplant 2011;9:14-9.  Back to cited text no. 19
Mjøen G, Hallan S, Hartmann A, et al. Long- term risks for kidney donors. Kidney Int 2014;86:162-7.  Back to cited text no. 20

Correspondence Address:
Delphine Amélie Lagou
Service of Nephrology, Dialysis and Hypertension, Yopougon Teaching Hospital, 21 BP 632 Abidjan 21
Côte d'Ivoire
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DOI: 10.4103/1319-2442.182400

PMID: 27215251

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  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]


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