Outcomes of Living Kidney Donors Following Donor Nephrectomy in Aotearoa New Zealand

Introduction: Living donor kidney transplantation is the optimal treatment for people with kidney failure (KF). Because living donors do not derive health benefits from donation, contemporary relevant information on post donation outcomes need to inform decision-making. Studies of donor outcomes are largely restricted to donations in the USA and Europe. We studied donors over a 30-year period in Aotearoa New Zealand (NZ) to investigate short-term and long-term outcomes. Methods: This was a retrospective observational cohort study of all living kidney donors in NZ (1988–2018). The primary outcome was the incidence of KF. Secondary outcomes were death, cardiovascular disease (CVD), and the incidence of complications within 90 days after nephrectomy. Donors were identified using multiple data sources: the NZ Blood Service, the Ministry of Health (MoH), hospital records, and the Australia and New Zealand Live Kidney Donor Registry. Outcomes were determined via data linkage with the Australia and New Zealand Dialysis and Transplant (ANZDATA) registry and the MoH. Follow-up was until December 31, 2019. Results: A total of 1339 people donated a kidney from 1988 to 2018. During 16,272 person-years of follow-up, 5 people developed KF, an incidence of 3 per 10,000 person-years (95% confidence interval [CI]:1.3–7.4). Patient survival was 99% (98.2%–99.5%) at 10 years; 30 people died during follow-up. The incidence of CVD was 11.6 (95% CI: 7.4–19.2) per 10,000 person-years; 292 donors (22%) experienced a complication following donor nephrectomy and 69 (5%) required intervention. Conclusion: There is a low risk of KF and other complications among living kidney donors in NZ. These findings represent important contemporary data to support decision making.