Self-Reported Outcome of Living Kidney Donation Correlates With Perioperative Complications not With Surgical Techniques

Abstract

Introduction: The German health care system lacks data on surgical complications and self-reported outcomes (SROs) of living donors. The prospective German Living Kidney Donor Registry, SOLKID-GNR aims to improve the assessment of donors' medical and psychosocial risks.

Methods: Data were collected before (PRE) and 3 months after (POST) living kidney donation from transplantation centers (TCs) and donors via SROs. We reported perioperative complication rates for different surgical techniques and correlated them with donors' SROs. Datasets of 1020 donors from 30 German TCs were analyzed.

Results: Donor nephrectomy procedures included laparoscopic (57.9%), retroperitoneoscopic (21.4%), open retroperitoneal (16.0%), or open abdominal nephrectomy (4.7%). Perioperative complications reported by TCs ranged from 9.8% (retroperitoneoscopic) to 17.1% (open abdominal), whereas those reported by donors ranged from 12.2% (open retroperitoneal) to 15.0% (open abdominal). Donors were discharged sooner and returned to work earlier after minimally invasive surgery; however, had comparable quality-of-life (QoL) after donation. The physical component summary (PCS) scores of the Short Form-12 (SF-12) were similar between the 4 surgical methods postdonation; however, they were lower in donors with TC- or self-reported complications than in those without. The mental component summary (MCS) scores of the SF-12 were lower in case of self-reported complications only. Despite 12.5% of self-reported complications, 96.4% expressed a willingness to donate again, and 94.1% felt well-informed.

Conclusion: Although the surgical technique does not directly affect donors' QoL shortly after donation, minimally invasive procedures result in shorter hospital stays and a quicker return to work. Self-reported complications have a greater impact on mental QoL than those documented by transplant centers, highlighting the importance of subjective experiences during recovery.

Keywords: living kidney donation; self-reported outcome; surgical complication; surgical techniques; transplantation.

Graphical abstract

Figure 1

(a) Results for the physical component summary score (PCS) of the SF-12 questionnaire for the different surgical techniques before (PRE) donation (green) versus 8–14 weeks after donation (blue) compared with the mean value (45.72, blue line) ± SD (8.79, red line) for “normal” persons aged 51 to 60 years. Differences between surgical techniques were not significantly different. PRE donation: LDN: n = 573; OAN: n = 47; ORN: n = 162; RDN: n = 211. 8–14 weeks POST donation: LDN: n = 418; OAN: n = 21; ORN: n = 98; RDN: n = 138. (b) Results for the physical component summary score (PCS, left) and the mental component summary score (MCS, right) of the SF-12 questionnaire for donors without (green) and with (blue) perioperative complications. Included were all donor questionnaires where complications were reported between 8 weeks and 6 months POST donation by the transplant center (TC) or 8–14 weeks for the self-reported complications by the donors. Data were compared with mean values (45.72 [PCS] and 51.38 [MCS], blue line) ± SD (8.79 [PCS] and 9.04 [MCS], red line) for “normal” persons aged 51–60 years. Statistically significant differences were shown within the figure. TC: no: n = 713; yes: n = 111; Donors: no: n = 587; yes: n = 84. LDN, laparoscopic donor nephrectomy; n.s., not significant; OAN, open abdominal nephrectomy; ORN, open retroperitoneal nephrectomy; RDN, retroperitoneoscopic donor nephrectomy; SF-12, Short Form–12 questionnaire.