Health Related Quality of Life (HRQOL) after Donating a Kidney: Do Kidney Donors Feel the Same as Those Who Lose a Pathological Kidney

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Abstract

Objective

Kidney donors are not patients, tend to be healthier, able to tolerate a major surgery and return to healthy life style soon. Patient reported health status and quality of life after nephrectomy is poorly understood, with varied differences between countries and races. However, most studies have suggested that donating a kidney may be associated with psychological benefit to the donor. A patient with a solitary kidney can live a near normal life without additional risk provided the patient was healthy prior to surgery. We evaluated the HRQoL in patients following laparoscopic donor nephrectomy and compared with patients after laparoscopic radical nephrectomy for organ confined renal cancer and a control group of healthy individuals.

Material

Three groups of 30 patients in each; those who underwent donor nephrectomy, radical nephrectomy and healthy individuals were selected for the study. Patients had undergone surgery during the period between January 2015 to October 2016 at Sri Jayawardenapura teaching hospital, Colombo.

Method

After a minimum period of one year follow up, the first two groups were evaluated using medical outcome study short form (SF -36) questionnaire.( Cronbach’s alpha >0.7) The mean scores of eight different domains were calculated (1 to 100) and compared between the three groups using 2-tailed t test/ SPSS -16. Statistical significance was taken as P<0.05.

Results

In two out of eight domains ("physical function" and "role limitation due to emotional problems") patients with renal malignancies scored significantly poorer scores than the control group(P<0.05). In addition to these two, three other domains (“social function”, “role limitation due to physical function” and “pain”) were significantly poorly scored by kidney donors ( P<0.05). Interestingly donors had significantly poorer scores in terms of “role limitation to physical health”,” emotional problems” and “fatigue” when compared with the group of patients who underwent radical nephrectomy (P<0.05). Also 63.33% of patients in the radical nephrectomy group reported that they feel better change in their health status over the past 1 year. This is in contrast to 43.33% of donor nephrectomy group reporting a worse health status during the past year after the surgery.

Conclusion

The HRQoL of living kidney donors’ is poorer in certain domains when compared to kidney cancer patients and healthy individuals. This is probably due to the fact that kidney donors, who were previously healthy individuals, now considered themselves patients due to the major surgery they’ve undergone. This also highlights the need of an effective deceased donor programme to reduce the disincentives of living donation. Radical nephrectomy patients faired relatively better as they were now probably relieved of the mental burden of “cancer” with a hope of cure. Also preoperative counseling might lead to better outcomes among kidney donors.

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