Living related donor (LRD)
nephrectomies are controversial due to the risks to the donor and improved cadaveric graft survival using
cyclosporine A. Between December 22, 1970, and December 31, 1984, 1096 renal transplants were performed at a single institution, 314 (28.6%) from LRD. The average age was 34.3 years (range: 18-67); none had preoperative
hypertension. All
nephrectomies were performed transabdominally. Major perioperative complications occurred in 22 (7.0%). These include
wound infections (3.5%),
pancreatitis (1.0%),
injuries to spleen (1.0%) or adrenal gland (0.3%) requiring removal,
pneumonitis (0.6%),
ulnar nerve palsy (0.6%), femoral artery
thrombosis after arteriogram (0.3%), pulmonary
embolus (0.3%), and upper pole
infarct of contralateral kidney (0.3%). There are six known deaths in this series, none of which were related to the operation. Major late complications were seen in 50 (20.0%) of 250 patients followed for 6 to 175 months (mean 53.1 months). These included definite
hypertension (5.6%),
suture granuloma (4.4%),
incisional hernia (3.6%),
proteinuria (2.4%), bowel obstruction (2.0%),
nephrolithiasis (1.2%),
wound infection (0.4%),
scrotal hydrocele (0.4%), and
chronic pancreatitis (0.4%). While the risk of
hypertension appears to increase as the interval from donation increases, no cases of
renal failure after donation have been noted, and negligible
proteinuria among those followed long-term has been seen in this series. It is felt that living related kidney donation is justified when the relative is sincerely motivated and well informed prior to donation.