Minimizing morbidity of organ donation: Analysis of factors for perioperative complications after living-donor nephrectomy in the United States

Background. Expansion of living kidney donation through liberalizing acceptance criteria invites a renewed focus on safety and outcomes. Wide variability exists in reported donor complications, and associated risk factors are ill defined. Use of administrative data can overcome the bias of single-center studies and identify variables associated with untoward events. Methods. The study population consisted of 3074 living kidney donors from 28 centers during 2004 and 2005. Data from a large healthcare registry were used to retrospectively identify the study cohort. Perioperative complications were identified using ICD-9-CM coding and classified according to the Clavien system. Logistic regression models were constructed to identify donor and center factors associated with complications. Results. There were no perioperative deaths. The overall complication rate was 10.6% and major complications defined by Clavien grade ≥3 was 4.2%. The prevalence of tobacco use, obesity, and hypertension, was 7.8%, 2.4%, and 2.3%, respectively. Age<50 (odds ratio [OR]=1.81, 95% confidence interval [95% CI]=1.25-2.61), tobacco use (OR=1.41, 95% CI=1.02-1.94), obesity (OR=1.92, 95% CI=1.06 -3.46), and annual center volume ≤50 (OR=2.28, 95% CI=1.68 -3.09), were significantly associated with overall morbidity, however only annual center volume ≤50 (OR=2.07, 95% CI=1.27-3.37) was significantly associated with a risk of major complications. Conclusions. The inclusion of donors with tobacco abuse, obesity, and age>50 increases complications; however, the risk of major morbidity is small. Use of administrative data represents an important tool to facilitate the reconciliation of an increased need for organ donors with the concern for donor safety.