Outcomes of live renal donors with a history of nephrolithiasis; A systematic review
The clinical outcomes of kidney donors with a prior history of nephrolithiasis are poorly defined. We conducted a systematic review assessing the post-donation clinical outcomes of kidney donors with a history of nephrolithiasis. Electronic databases (Ovid and Embase) were searched between 1960 and 2021 using key terms and Medical Subject Headings (MeSH) - nephrolithiasis, renal stones, renal transplantation and renal graft. Articles included conference proceedings and journal articles and were not excluded based on patient numbers. Primary outcome was donor stone-related event. Secondary outcomes were renal function upon follow-up or post-operative nephrectomy complications. In summary, 340 articles were identified through database search. We identified 14 studies (16 cohorts) comprising 432 live donors followed up for a median of 26 months post live kidney donation. Six donors donated the stone-free kidney whilst 23 live donors had bilateral stones. Mean stone size was 4.2 ± 1.4 mm (1-16) with average follow up duration of 21.1 months (1-149). Twelve studies provided primary outcome (n = 138 patients) and eight (n = 348) for secondary outcomes. One donor had a stone-related event upon follow up. A total of 195 patients had eGFR <60 upon follow up. However, they were not significantly different when compared to renal function of live donors that didn't have pre-donation nephrolithiasis. Many of the studies couldn't provide long term follow up, coupled with limited data regarding the nature of the pre-donation stone disease. In conclusion, this systematic review shows that we have very limited information upon which to base recommendation regarding pre-donation risk of post-donation complications. Longer term follow up is required and lifelong follow up with live donor registries will aid further understanding.
CET Conclusion
| Reviewer: | Mr Simon Knight, Centre for Evidence in Transplantation, Nuffield Department of Surgical Sciences University of Oxford |
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| Conclusion: | This systematic review explores the published data regarding living kidney donors with a history of renal stones. The authors identified 14 studies of 432 patients, identifying just one patient with a reported stone-related event. However, the identified studies were limited in quality and detail, and the average follow-up was just 21.1 months. Review methodology is good, with protocol registration, thorough literature search strategies and quality assessment. The authors make the best of the literature available with a comprehensive and well-written summary, but as they point out, there is significant risk of publication bias and under-reporting. More robust long-term registry data is required to truly quantify the risk to donors with existing stone disease. |
Study Details
| Aims: | This study aimed to investigate the outcomes of kidney donors with a prior history of nephrolithiasis following donation. |
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| Interventions: | A literature search was conducted on Ovid and Embase. Eligible studies were selected by two independent reviewers. The Newcastle-Ottawa scale was used to assess the quality of the included studies. |
| Participants: | 14 studies were included the review. |
| Outcomes: | The primary outcome was stone-related event including stone-formation following donation, stone-induced obstruction, acute renal failure and sepsis. The secondary outcomes included short-term (≤30 days) and long-term (≥12 months) renal function. |
| Follow Up: | N/A |
Metadata
| Funding: | Funding not described |
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| Publication type: | Review, Systematic Review |
| Review registration: | CRD42021271244 |
| Organ: | Kidney |
| Language: | English |
| Author email: | mohdeftal@gmail.com |
| MeSH terms: | Humans; Living Donors; Kidney; Nephrolithiasis; Kidney Transplantation; Nephrectomy |