Fathallah M. G, Fadel F. I, Saadi G. E, Mawla M. A. A, Salah D. M. Renal Outcome and Health Related Quality of Life of Living Related Donors In Pediatric Kidney Transplantation. Biomed Pharmacol J 2021;14(3).

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Manuscript received on :15-08-2021
Manuscript accepted on :27-09-2021
Published online on: 30-09-2021

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Plagiarism Check: Yes
Reviewed by: Dr. Kamlesh Jha
Second Review by: Dr. Hind Shakir
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Mohamed G. Fathallah¹ , Fatina I. Fadel¹, Gamal Eldin Saadi³ ,  Mohamed A. Abdel Mawla² and Doaa M. Salah¹

¹Department of Pediatrics, Cairo University, Cairo, Egypt

²Departmentof Pediatrics, National Research Center, Giza, Egypt

³Department of Internal Medicine, Cairo University, Cairo, Egypt

Corresponding Author E-mail: mohammad.gamal@hotmail.com

DOI : https://dx.doi.org/10.13005/bpj/2242

Abstract

Objectives To assess the health related quality of life of living related donors after kidney transplantation and to evaluate clinical ,social and psychological  condition post donation Study design This is an observational cross sectional  study that included fifty living related donors of kidney transplant. All donors were assessed after at least one year of kidney donation. Data of the study was collected between April, 2019 and March, 2020. Methods The study included 50 living related donors;All donors were assessed after at least one year of kidney donation.WHOQOL-bref questionnaire (world health organization quality of life ) was used to assess quality of life of donors. Results The mean age at time of transplantation was 35.4±7.89 years. Eight  cases developed hypertension after transplantation. There was no significant difference between serum creatinine before and after transplantation while there was significant decrease in glomerular filtration rate post transplantation. There was significant increase in fasting blood glucose and cholesterol in female donors compared to males.The results of the WHOQOL-bref questionnaire showed significant difference in results of psychological, social and environmental domains pre and post donation. Conclusion Proper selection of donors is very important to avoid complications post transplantation. Follow-up of donors should be maintained after donation.

Keywords

Donor; follow up  Transplantation

Introduction

Renal transplantation provides a better prognosis and long-term benefit to chronic kidney diseases patients ¹.Kidney transplantation using grafts from living donors has increased along with the need for renal transplantation. Living-donor transplants provide more satisfyinggraft function and survival compared with deceased-donors². Many studies have been done to check the risks. The results have showed that risks and benefits are presentin living donation. Kidney donation doesn’t cause physical benefit for the donor, but psychologic benefit are present (a sense of gratification). It isimportant to clarify the risks to make informed andadequate decisions ^3,4.The inclusion criteria of the living donation have been extended and older donors and donors with minor problems such as hypertension have been accepted for donation ⁵. However, it must be noted that live donor nephrectomy is performed on healthypeople who do not need any intervention. So, donor safety andclose follow up remains important point in living kidney donation. It has been found that kidney function might be impaired immediately after donation and recovers within the first year. Previous studies suggest that renal function reached at 1 year postdonation remains stable at least for over the next decade but then impaired  with ageing ⁶.

Previous studies showed that survival and quality of life (Qol) in living kidney donors are nearly similar to the general population ⁷. However according to recent studies kidney donors suffered from proteinuria, hypertension,and ESRD ^8.9

An excellent method for QOL assessment in living donor transplantations has not been agreed upon. There are new studies discussing  living donor transplant in different countries, most of them using the Medical OutcomesStudy Questionnaire 36-Item Short-formHealth Survey (SF-36) or, the WHOQOL-bref Questionnaire (World Health Organization Quality of Life-brief) ^{10, 11}

The WHOQOL-brefincludes 26 items; the first two questions evaluate overall quality of life health satisfaction. The other 24 questions represent each of the 24 facets of which the original instrument is composed (WHOQOL-100), divided into four domains: physical, psychological, social relationships and environment. The mean score in each domain measures donor  satisfaction with each aspect of their life, relating it with quality of life. The higher the score, the better this is perceived to be ¹²

Method

This is an observational cross sectional  study that included fifty living related donors of kidney transplant for pediatric recipients. Included donors were randomly recruited during follow up of their related pediatric transplant recipients in Kidney Transplantation Outpatient Clinic, Cairo University Children Hospital. All donors were assessed after at least one year of kidney donation. Data of the study was collected between April, 2019 and March, 2020.

The study was ethically reviewed and approved by Pediatric Nephrology Unit, Department of Pediatrics, Faculty of Medicine, Cairo University and medical research ethical committee in the National Research Center. All procedures followed were in accordance with the Helsinki Declaration of 1964.

For all donors, kidney transplantation (KT) operation was performed in Cairo University Children Hospital, in which only living related donor transplants (LRDT) are allowed. Donors were followed up for at least 3 months post-transplant medically and surgically in our unit, then were referred for long-term follow-up in adult Nephrology department, Kasr Al Ainy Hospital.

Pre-transplantation medical data (as diabetes and hypertension), intraoperative details (as time of the operation, side of donor nephrectomy, number of renal transplant vessels) and early post-operative complications (as pneumothorax or chest/wound infection) were obtained by reviewingthe medical records. Late complications (as wound incisional hernia) were also reported.

Donor clinical and laboratory assessment was performed during their recruitment in the study. Blood pressure, fasting blood glucose, serum albumin, uric acid, cholesterol and triglycerides were measured. Kidney function was assessed by serum creatinine and quantitative urine protein assessment. GFR was calculated by modified Schwartz formula. Health Related Quality of Life (HRQOL) was evaluated for all donors using WHOQOL-bref questionnaire pre and post donation.

Statistical Package for Social Sciences version 15 (SPSS, Chicago, Ill) was used to analyze collected data. Nominal data were expressed as frequencies and percentage, parametric data as means and standard deviations (SD) and non-parametric data as median and range or interquartile range (IQR). Associations between the outcome measures and different components were tested for significance by using Chi-square test for categorical variables and the paired student t- test for continuous variables with normally distributed data. P value less than 0.05 was considered statistically significant.

Results

As seen in table 1 The study included Fifty living donors 24 males and 26 females. The mean age at time of transplantation was 35.4±7.89 years.  The mean follow up duration post transplantation was 4.9±2.78 years.Rt donor nephrectomy was done in 31 donor while Lt was in 19.Single renal Artery was in 40 cases while double renal artery was found in 9 cases and triple renal artery was found in one donor .The mean systolic blood pressure was 139 and diastolic blood pressure was 77. Five  donors were already hypertensive and controlled on Ca channel blockers and remained controlled post transplantation, while 8 cases developed hypertension after transplantation  and received treatment . Only one case developed Diabetes mellitus and started treatment.

Table 1: Demographic and clinical data of donors (n= 50)

Four cases developed incisional hernia post transplantation and were treated conservatively.The mean protiens in urine was 41.58 mg ptn/gm creatnine .Three donors developed microalbuminuria due to development of diabetes and hypertension.

There was no significant difference between serum creatinine before and after transplantation (p value 0.1161), while there was significant decrease in glomerular filtration rate post transplantation as seen in figure 1 (p value 0.0001).While comparing results of males and female donors There was significant increase in fasting blood glucose(FBG) and cholesterol in  female donors compared to males (Pvalue 0.023, 0.0019) . While there was significant increase in serum uric acid in male donors as seen in table 2.

Figure 1: Comparison between mean donor GFR pre and post transplantation Click here to view figure

Table 2: Comparison between males and females donors

The WHOQOL-bref questionnaire were used and the donors were subjected to the questionnaire before and after the transplantation.

The results of the WHOQOL-bref questionnaire was shown in table 3 and figure 2 . There was significant difference in results of psychological, social and environmental domains of WHOQOL-bref questionnaire.

Table 3: Results of different domains of WHOQOL-bref questionnaire.

Figure 2: Comparison of the quality of life of the living kidney donors before and after transplantation by WHOQOL-bref questionnaires click here to view figure

Discussion

Donor safety and close follow up remains important point in living kidney donation after transplantation. The study was conducted on 50 living donors with nearly same percentage of males and females . These results were nearly similar to Chatzikyrkou results which showed that male percentage of donors was 35%. ¹³ .The male percentage was higher in Dienemann et al study on donor hypertension which was 69%.¹⁴. The mean age at time of transplantation was 35.4±7.89. The age was younger than age of donors in many studies like Jankietal where the mean age of donors was 53 years ¹⁵.

The mean systolic blood pressure was 139 and diastolic blood pressure was 77. While 8 cases developed hypertension after transplantation. These results were higher than study done by Kasiske et al and studing 3 years follow up of donors where mean systolic and diastolic blood pressure were 120.7,74.5 respectively ¹⁶.while discussing long term consequences of live kidney donation Gossmann et al found that systolic and diastolic blood pressure were 134 and 81 respectively which was quite similar to our study ,they also noticed increase in the percentage of donors developed hypertension from 7 to 30 % 17.

There was significant decrease in glomerular filtration rate post transplantation ,similar to Gossmann et al where GFR decreased from 119 ± 30 to 99 ± 30 mL/min/1.73 m2  ¹⁷. These results were also similar to Park et al who were trying  to find tools to Predict Chronic Kidney Disease Risk in Living Kidney Donors post transplantation and found decline in GFR <60 mL/min/1.73 m2 1 year post transplantation .This was correlated with old age , hypertension , serum uric acid, and creatinine levels, and lower serum calcium levels.

The results of the multivariate analysis found  that olderpatients and those with higher serum creatinine levels andlower serum calcium levels had a significantly greater risk ofdeveloping CKD ¹⁸.Chatzikyrkou et al also reported decline in GFR after 1 year donation when compared to that pre donation and found that decline in GFR was correlated with older age ¹³.

Our results were also similar to janki et al in 5 years follow  up of donors where they find that half of  donors developed low GFR  < 60 ml/min/

1.73 m2. and found that decline may be due to older age at time of donation  or having a lower eGFR before transplantation ¹⁹.

The WHOQOL-bref questionnaire was used and the donors were subjected to the questionnaire before and after the transplantation.

The results showed no significant changes in the physical domain while there were significant changes and improvement in the social, psychological and environmental domains and in the overall QOL and general health before and after donation. These results were due to the type of donors in our study who are related either mother, father, brother or uncle. These donors were ready to donate and even to loss their lives to keep their children transplanted and stop suffering of their kids that make the donation an altruistic behavior and made them satisfied. Our results was similar to Padra˜o and Sens results which discussed Quality of life of kidneydonors in Brazil by using short form-36 questionnaires and WHO QOL brief questionnaire comparing donors with control group –unlike our study- and found no significant changes regarding physical domain but showed significant increase in remaining domains when compared to control group ²⁰. Our results were also similar to Vemuru Reddy SK et al Where donors showed significant improvement in the QOL in the physical, Psychological and environmental domain before and after organ donationand non-significant improvement in the social relationship ²¹.

On contrast Lumsdaine et alassessed the donor QOL before, six weeks and one year after donation, and found declined QOL six weeks after the donation , but results improved one year after donation . These results may be due to the early time of assessment after donation. ²².Erim et al also found significant decline in quality of life 3 months post transplantation while assessing quality of life in more than 150  living kidney donors before and after donation and assuming that cause may be due to the early time point of assessment ^23.Nejatisafa et al reported low QOL after donation while discussing QOL in unrelated donors post donation and found the reason that most  of kidney donors in Iran are unrelated  whose main motivation is “a financial gain” ^22.

Conclusion

This study has concluded  that related living kidney donation  does not negatively  affect the lives ofdonors and may improves many social, psychological and environmental aspects  of their lives. Careful donor selection  is very important point to provide good physical quality of life post donation. The majority ofliving related  donors would donate again and again to protect their children.

Acknowledgment

To all our heroes who donated for their children to have better life not afraid of having health problems post donation, just scarifying their life for their children .

Conflict of intersest

The authors declare no conflicts of interest

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