The Netherlands was the first European country to implement unspecified kidney donation in 2000. This qualitative study aimed to evaluate the experiences of unspecified kidney donors (UKDs) in our transplant institute to improve the care for this valuable group of donors. We conducted semi-structured interviews with 106 UKDs who donated between 2000-2016 (response rate 84%). Interviews were audio-recorded, transcribed verbatim and independently coded by 2 researchers in NVivo using thematic analysis. The following 14 themes reflecting donor experiences were found: Satisfaction with donation; Support from social network; Interpersonal stress; Complaints about hospital care; Uncertainty about donor approval; Life on hold between approval and actual donation; Donation requires perseverance and commitment; Recovery took longer than expected; Normalization of the donation; Becoming an advocate for living kidney donation; Satisfaction with anonymity; Ongoing curiosity about outcome or recipient; Importance of anonymous communication; Anonymity is not watertight. The data reinforced that unspecified kidney donation is a positive experience for donors and that they were generally satisfied with the procedures. Most important complaints about the procedure concerned the length of the assessment procedure and the lack of acknowledgment for UKDs from both their recipients and health professionals. Suggestions are made to address the needs of UKDs.

The Kidney Team at Home program is an educational intervention aimed at patients with chronic kidney disease to assist them in their choice for kidney replacement therapy. Previous studies have shown that the intervention results in an increase in knowledge and communication on kidney replacement therapy, and eventually in an increase in the number of living donor kidney transplantations. The study assesses the cost-effectiveness of the intervention compared to standard care. A dynamic probabilistic Markov model was used to estimate the monetary and health benefits of the intervention in The Netherlands over 10 years. Data on costs and health-related quality of life were derived from the literature. Transition probabilities, prevalence, and incidence rates were calculated using a large national database. An optimistic and a pessimistic implementation scenario were compared to a base case scenario with standard care. In both the optimistic and pessimistic scenario, the intervention is cost-effective and dominant compared to standard care: savings were €108,681,985 and €51,770,060 and the benefits were 1382 and 695 QALYs, respectively. The superior cost-effectiveness of the intervention is caused by the superior health effects and the reduction of costs associated with transplantation, and the relatively small incremental costs of the intervention. The favorable findings of this implementation project resulted in national uptake of the intervention in The Netherlands as of 2021. This is the first time a psychosocial intervention has been implemented as part of standard care in a kidney replacement therapy program worldwide.

Objective: Investigate the influence of health literacy and self-management on complications, kidney function and graft failure after kidney transplantation. Methods: We included patients who received a kidney transplant between May 2012 and May 2013 and monitored outcomes until December 2018. Health literacy was measured using the Newest Vital Sign and self-management using the Partner in Health scale (before discharge, and after 6 and 12 months). Subscales are aftercare & knowledge, coping, recognition and management of symptoms, healthy lifestyle. Complications were categorized as rejection, viral infections, and bacterial infections. Kidney function was measured using eGFR and graft survival using days until failure. Results: We included 154 patients. Higher health literacy at baseline and at 12 months was related to more viral infections (p = 0.02; p < 0.01). Lower 'coping' at baseline was related to more bacterial infections (p = 0.02). Higher 'after-care and knowledge' at 6 months (p < 0.01), and 'recognition and management of symptoms' at 6 months were associated with lower graft failure (p < 0.01). Conclusion: Health literacy did not influence kidney transplant related outcomes. Higher knowledge and management of symptoms were related to lower graft failure. Practice implications: Self-management support is a key focus for health care providers in the multidisciplinary team. (c) 2021 Published by Elsevier B.V.

BackgroundSolid organ transplant recipients are at high risk to develop (complicated) herpes zoster (HZ). Booster vaccination could prevent HZ. However, end-stage renal disease (ESRD) patients show poor immunological responses to vaccinations. We studied the effect of a live attenuated VZV booster vaccine on VZV-specific B and T cell memory responses in ESRD patients and healthy controls. NL28557.000.09, www.toetsingonline.nlMethodsVZV-seropositive patients, aged ≥50 years, awaiting kidney transplantation, were vaccinated with Zostavax®. Gender and age-matched VZV-seropositive potential living kidney donors were included as controls. VZV-specific IgG titers were measured before, at 1, 3 and 12 months post-vaccination. VZV-specific B and T cell responses before, at 3 months and 1 year after vaccination were analysed by flow-cytometry and Elispot, respectively. Occurrence of HZ was assessed at 5 years post-vaccination.Results26 patients and 27 donors were included. Median VZV-specific IgG titers were significantly higher at all time-points post-vaccination in patients (mo 1: 3104 IU/ml [1967-3825], p<0.0001; mo 3: 2659 [1615-3156], p=0.0002; mo 12: 1988 [1104-2989], p=0.01 vs. pre: 1397 [613-2248]) and in donors (mo 1: 2981 [2126-3827], p<0.0001; mo 3: 2442 [2014-3311], p<0.0001; mo 12: 1788 [1368-2460], p=0.0005 vs. pre: 1034 [901-1744]. The patients’ IgG titers were comparable to the donors’ at all time-points. The ratio VZV-specific B cells of total IgG producing memory B cells had increased 3 months post-vaccination in patients (0.85 [0.65-1.34] vs. pre: 0.56 [0.35-0.81], p=0.003) and donors (0.85 [0.63-1.06] vs. pre: 0.53 [0.36-0.79], p<0.0001) and remained stable thereafter in donors. One year post-vaccination, the percentage of CD4+ central memory cells had increased in both patients (0.29 [0.08-0.38] vs. 0.12 [0.05-0.29], p=0.005) and donors (0.12 [0.03-0.37] vs. 0.09 [0.01-0.20], p=0.002) and CD4+ effector memory cells had increased in donors (0.07 [0.02-0.14] vs. 0.04 [0.01-0.12], p=0.007). Only 1 patient experienced HZ, which was non-complicated.ConclusionVZV booster vaccination increases VZV-specific IgG titers and percentage VZV-specific memory T-cells for at least 1 year both in ESRD patients and healthy controls. VZV-specific memory B cells significantly increased in patients up to 3 months after vaccination. Prophylactic VZV booster vaccination prior to transplantation could reduce HZ incidence and severity after transplantation.

Objectives. Unspecified donors give a kidney to a stranger with end-stage kidney failure. There has been little research on the long-term impact of unspecified donation on mental health outcomes. The aim of this study was to assess the positive and negative aspects of mental health among unspecified donors. Design. We invited all unspecified donors who donated a kidney between 2000 and 2016 at our centre to participate in an interview and to complete validated questionnaires. Methods. We measured positive mental health using the Dutch Mental Health Continuum-Short Form (MHC-SF), psychological complaints using the Symptoms Checklist-90 (SCL-90) and psychiatric diagnoses using the Mini-International Neuropsychiatric Interview (M.I.N.I.) Screen for all donors and the M.I.N.I. Plus on indication. Results. Of the 134 eligible donors, 114 participated (54% female; median age 66 years), a median of 6 years post-donation. Scores on emotional and social well-being subscales of the MHC-SF were significantly higher than in the general population. Psychological symptoms were comparable to the general population. Thirty-two per cent of donors had a current or lifetime psychiatric diagnosis. Psychological symptoms did not significantly change between the pre-donation screening and the post-donation study. Conclusions. We concluded that, with the appropriate screening, unspecified donation is a safe procedure from a psychological perspective.

There are three notable aspects of the current kidney replacement therapy program. First, the number of patients on home dialysis has dropped substantially over the last decades. Second, the rate of transplantation has stabilized in recent years. Third, there is variation in referral rate for transplantation among hospitals. These trends are the result of overutilization of in-center dialysis and that demand for kidney replacement therapy is moderated by suppliers. Current healthcare policy leads to overutilization of in-center dialysis and underutilization of home dialysis and transplantation. This overutilization is the result of supplier-induced demand and leads to suboptimal care for patients and excessive healthcare expenditures. The main drivers of this overutilization are the overcapacity of in-center dialysis beds and the high financial disincentives on empty dialysis beds. Policymakers should address this by reducing dialysis capacity and increasing the capacity of transplantation facilities. This is the first attempt to address the overutilization and the nonalignment of supply and demand by looking at the capacity of in-center dialysis and the financial disincentives for physicians on empty in-center dialysis beds. In our analysis, we conclude that limiting the capacity of in-center dialysis beds is the most effective strategy to better align supply and demand, which will result in better patient outcomes and lower societal costs.

Research has shown that a home-based educational intervention for patients with chronic kidney disease results in better knowledge and communication, and more living donor kidney transplantations (LDKT). Implementation research in the field of renal care is almost nonexistent. The aims of this study were (1) to demonstrate generalizability, (2) evaluate the implementation process, and (3) to assess the relationship of intervention effects on LDKT-activity. Eight hospitals participated in the project. Patients eligible for all kidney replacement therapies (KRT) were invited to participate. Effect outcomes were KRT-knowledge and KRT-communication, and treatment choice. Feasibility, fidelity, and intervention costs were assessed as part of the process evaluation. Three hundred and thirty-two patients completed the intervention. There was a significant increase in KRT-knowledge and KRT-communication among participants. One hundred and twenty-nine out of 332 patients (39%) had LDKT-activity, which was in line with the results of the clinical trials. Protocol adherence, knowledge, and age were correlated with LDKT-activity. This unique implementation study shows that the results in practice are comparable to the previous trials, and show that the intervention can be implemented, while maintaining quality. Results from the project resulted in the uptake of the intervention in standard care. We urge other countries to investigate the uptake of the intervention.

Background After kidney transplantation non-adherence and inadequate self-management undermine clinical outcomes and quality of life. Both have been demonstrated to be substantial in all age groups. However, interventions promoting adherence and self-management among kidney transplant recipients that have proven to be effective are scarce. In this study we aim to develop and test an intervention to optimize adherence and self-management. In this article we describe the background and design of the trial entitled ‘promoting Medication AdheRence and Self-management among kidney transplant recipients’ (MARS-trial)’. Methods/design This is a single-center, parallel arm randomized controlled trial. Nonadherent kidney transplant recipients aged 12 years or older are eligible for inclusion. Patients will be randomly assigned to either the experimental or a control group. The control group will receive care-as-usual. The experimental group will receive care-as-usual plus the MARS-intervention. The MARS-intervention is an outreaching intervention, based on the principles of (multi) systemic therapy which means involving the social network. A standardized intervention protocol is used for consistency but we will tailor the behavior change techniques used to the specific needs and determinants of each patient. The primary outcome of medication adherence will be measured using electronic monitoring. Secondary outcome measures regarding medication adherence and self-management are also assessed. Data is collected at baseline (T0), after a run-in period (T1), at six months post-baseline/end of treatment (T2) and after a six month follow-up period (T3). Discussion We combined elements of (multi) systemic therapy and evidence-based behavior change techniques to create an outreaching and highly individualized intervention. In this trial we will investigate the impact on medication adherence and self-management after kidney transplantation. Trial registration Netherlands Trial Register,trial number NTR7462. Registered 7th September 2018, https://www.trialregister.nl/trial/7264

The Kidney Team at Home Consortium. Introduction: Research has shown that home-based education for patients with end-stage renal disease results in better knowledge and communication on renal replacement therapy (RRT) options, and more living donor kidney transplantations compared to care-as-usual. However, these studies were conducted in one region in the Netherlands. The aims of this study were (1) to assess whether the effects can be replicated when the intervention is implemented nationally thus demonstrating generalizability, and (2) to evaluate the implementation process. Methods: In the period 2016-2019, 4 university hospitals and 4 regional hospitals in 4 (out of 7) regions of the Netherlands participated in the implementation project. Both patients undergoing dialysis and those not yet undergoing RRT were invited to participate. The intervention was delivered by trained social workers, psychologists and nurses. Effect outcomes were measured using questionnaires on patients’ and invitees’ knowledge on RRT, frequency of communication about RRT, and treatment modality during the 24 month follow-up period after the intervention. Feasibility (participation rate), fidelity (protocol adherence), and implementation costs (intervention costs) were assessed as part of the process evaluation. Feasibility was assessed by keeping track of all patients approached for the intervention. Fidelity was measured through an independent evaluation by phone with patients and invitees. Intervention costs were estimated using a micro-costing approach. Results: 1209 patients with end-stage renal disease were approached for the intervention and 505 interventions were conducted. There was a significant increase in knowledge and communication on RRT among both patients and invitees. Among participants with a minimum of 6 months follow-up data, 67 patients had undergone a living donor kidney transplantation and another 64 patients were in preparation for live donor transplantation donation. Participation rate per hospital varied between 32.9% and 100%. The average protocol adherence score was 4.69 out of 5, and is positively correlated with the probability that a patient ends up undergoing or in preparation for a living donor transplantation. Intervention cost is estimated to be between €2500 and €3000 per patient educated. Discussion: Results show that the intervention can be implemented in multiple regions with varying patient populations in The Netherlands, while maintaining impact and quality. The results also suggest that a high degree of protocol adherence increases the probability that a patients ends undergoing or in preparation for a living donor transplantation, and thus, proves the merit of the protocol. Variability among the hospitals in terms of feasibility might be the result of how patients were selected and approached, and the degree to which the intervention was embedded in the established nephrology care path. We recommend uptake of the Kidney Team at Home in standard-care and structural financing for this effective form of education.

Live donor nephrectomy is a safe procedure. However, long-term donor prognosis is debated, necessitating high-quality studies. A follow-up study of 761 living kidney donors was conducted, who visited the outpatient clinic and were propensity score matched and compared to 1522 non-donors from population-based cohort studies. Primary outcome was kidney function. Secondary outcomes were BMI (kg/m2), incidences of hypertension, diabetes, cardiovascular events, cardiovascular and overall mortality, and quality of life. Median follow-up after donation was 8.0 years. Donors had an increase in serum creatinine of 26 μmol/l (95% CI 24–28), a decrease in eGFR of 27 ml/min/1.73 m2 (95% CI − 29 to − 26), and an eGFR decline of 32% (95% CI 30–33) as compared to non-donors. There was no difference in outcomes between the groups for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and mortality. A lower risk of new-onset hypertension (OR 0.45, 95% CI 0.33–0.62) was found among donors. The EQ-5D health-related scores were higher among donors, whereas the SF-12 physical and mental component scores were lower. Loss of kidney mass after live donation does not translate into negative long-term outcomes in terms of morbidity and mortality compared to non-donors. Dutch Trial Register NTR3795.

BACKGROUND Optimal self-management in kidney transplant recipients is essential for patient and graft survival, reducing comorbidity and health care costs while improving the quality of life. However, there are few effective interventions aimed at providing self-management support after kidney transplantation. OBJECTIVE This study aims to systematically develop a nurse-led, self-management (support) intervention for kidney transplant recipients. METHODS The Intervention Mapping protocol was used to develop an intervention that incorporates kidney transplant recipients’ and nurses’ needs, and theories as well as evidence-based methods. The needs of recipients and nurses were assessed by reviewing the literature, conducting focus groups, individual interviews, and observations (step 1). Based on the needs assessment, Self-Regulation Theory, and the “5A’s” model, change objectives were formulated (step 2). Evidence-based methods to achieve these objectives were selected and subsequently translated into practical implementation strategies (step 3). Then, program materials and protocols were developed accordingly (step 4). The implementation to test the feasibility and acceptability was scheduled for 2015-2017 (step 5). The last step of Intervention Mapping, evaluation of the intervention, falls outside the scope of this paper (step 6). RESULTS The intervention was developed to optimize self-management (support) after kidney transplantation and targeted both kidney transplant recipients and nurse practitioners who delivered the intervention. The intervention was clustered into four 15-minute sessions that were combined with regular appointments at the outpatient clinic. Nurses received a training syllabus and were trained in communication techniques based on the principles of Solution-Focused Brief Therapy and Motivational Interviewing; this entailed guiding the patients to generate their own goals and solutions and focus on strengths and successes. Kidney transplant recipients were encouraged to assess self-management challenges using the Self-Management Web and subsequently develop specific goals, action plans, and pursuit skills to solve these challenges. CONCLUSIONS The Intervention Mapping protocol provided a rigorous framework to systematically develop a self-management intervention in which nurses and kidney transplant recipients’ needs, evidence-based methods, and theories were integrated. INTERNATIONAL REGISTERED REPOR DERR1-10.2196/11856

Background. Age criteria for kidney transplantation have been liberalized over the years resulting in more waitlisted elderly patients. What are the prospects of elderly patients on the waiting list? Methods. Between 2000 and 2013, 2622 patients had been waitlisted. Waiting time was defined as the period between dialysis onset and being delisted. Patients were categorized according to age upon listing: <25; 25–44; 45–54; 55–64; and >64 years. Furthermore, the influence of ABO blood type and panel reactive antibodies on outflow patterns was studied. Results. At the end of observation (November 2017), 1957 (75%) patients had been transplanted, 333 (13%) had been delisted without a transplantation, 271 (10%) had died, and 61 (2%) were still waiting. When comparing the age categories, outflow patterns were completely different. The percentage of patients transplanted decreased with increasing age, while the percentage of patients that had been delisted or had died increased with increasing age, especially in the population without living donor. Within 6 years, 93% of the population <25 years had received a (primarily living) donor kidney. In the populations >55 years, 39% received a living donor kidney, while >50% of patients without a living donor had been delisted/died. Multivariable analysis showed that the influence of age, ABO blood type, and panel reactive antibodies on outflow patterns was significant, but the magnitude of the influence of the latter 2 was only modest compared with that of age. Conclusions. “Elderly” (not only >64 y but even 55–64 y) received a living donor kidney transplantation less often. Moreover, they cannot bear the waiting time for a deceased donor kidney, resulting in delisting without a transplant in more than half the population of patients without a living donor. Promoting living donor kidney transplantation is the only modification that improves transplantation and decreases delisting/death on the waiting list in this population.

Aim: Anonymous living kidney donors donates to an unknown stranger. These donors undergo psychosocial assessment to minimize likelihood of psychological harm from donation. The aim of this retrospective interview study was to investigate post-donation psychological symptoms, well-being and psychiatric diagnoses. Methods: All 147 unspecified anonymous kidney donors (2000-2016) in our center were eligible to participate. The structured interview MINI Screen was used to assess psychiatric diagnoses: on indication the M.I.N.I. plus was conducted. Questionnaires were used to assess psychological symptoms (Symptoms Checklist) and psychological well-being (Dutch Mental Health Continuum). We also conducted a semi-structured interview about expectations, anonymity, experiences and the support received. Results: Of the 147 eligible, 11 had died: 114/136 participated (84% participation rate). Fifty-two were male, median age was 66.5 (25-94) years, and the follow-up time 76.5 (24-178) months. Participants scored higher on positive well-being than the general population. Psychological complaints were comparable to the general population. Regarding psychiatric diagnosis, 54/114 (47%) donors had an indication for a diagnosis for which the M.I.N.I. plus was conducted; a lifetime diagnosis was established among 36 (32%). Most common diagnosis were depression and post-traumatic stress disorder. Conclusion: Willingness to participate in this study was very high. The rate of psychological symptoms at the time of the interview and life-time psychiatric diagnoses is comparable with prevalence in the general population. Whereas psychological well-being generally is higher than the general population. Qualitative interview data are currently being analyzed. Prospective studies are needed to assess symptoms and well-being on the long-term taking baseline levels into consideration in order to determine the burden and gains of unspecified donation.

BACKGROUND:Living donor kidney transplantation (LDKT) is the preferred treatment for patients with end-stage renal disease and unspecified living kidney donation is morally justified. Despite the excellent outcomes of LDKT, unspecified kidney donation (UKD) is limited to a minority of European countries due to legal constraints and moral objections. Consequently, there are significant variations in practice and approach between countries and the contribution of UKD is undervalued. Where UKD is accepted as routine, an increasing number of patients in the kidney exchange programme are successfully transplanted when a 'chain' of transplants is triggered by a single unspecified donor. By expanding the shared living donor pool, the benefit of LDKT is extended to patients who do not have their own living donor because a recipient on the national transplant list always completes the chain. Is there a moral imperative to increase the scope of UKD and how could this be achieved?METHODS:An examination of the literature and individual country practices was performed to identify the limitations on UKD in Europe and recommend strategies to increase transplant opportunities.RESULTS:Primary limitations to UKD, key players and their roles and responsibilities were identified.CONCLUSIONS:Raising awareness to encourage the public to volunteer to donate is appropriate and desirable to increase UKD. Recommendations are made to provide a framework for increasing awareness and engagement in UKD. The public, healthcare professionals, policy makers and society and religious leaders have a role to play in creating an environment for change.

Introduction Living donor kidney transplantation (LDKT) is the optimal treatment for most patients with end-stage renal disease (ESRD). However, there are numerous patients who cannot find a living kidney donor. Randomised controlled trials have shown that home-based education for patients with ESRD and their family/friends leads to four times more LDKTs. This educational intervention is currently being implemented in eight hospitals in the Netherlands. Supervision and quality assessment are being employed to maintain the quality of the intervention. In this study, we aim to: (1) conduct a cost-effectiveness analysis of the educational programme and its quality assurance system; (2) investigate the relationship between the quality of the implementation of the intervention and the outcomes knowledge, communication and LDKT activities; and (3) investigate policy implications. Methods and design Patients with ESRD who do not have a living kidney donor are eligible to receive the home-based educational intervention. This is carried out by allied health transplantation professionals and psychologists across eight hospitals in the Netherlands. The cost-effectiveness analysis will be conducted with a Markov model. Cost data will be obtained from the literature. We will obtain the quality of life data from the patients who participate in the educational programme. Questionnaires on knowledge and communication will be used to measure the outcomes of the programme. Data on LDKT activities will be obtained from medical records up to 24 months after the education. A protocol adherence measure will be assessed by a third party by means of a telephone interview with the patients and the invitees. Ethics and dissemination Ethical approval was obtained through all participating hospitals. Results will be disseminated through peer-reviewed publications and scientific presentations. Results of the cost-effectiveness of the educational programme will also be disseminated to the Dutch National Health Care Institute. Trial registration number NL6529

AIMSThis study investigated self-management challenges and support needs experienced by kidney transplant recipients.BACKGROUNDAfter kidney transplantation, recipients are expected to take an active role in self-management. However, evidence suggests that nurses experience difficulties operationalizing self-management support. Greater insight into the recipients' perspective could help to improve the adequacy and efficacy of nurse-led self-management support.DESIGNA cross-sectional qualitative study.METHODSFocus groups and individual interviews were carried out with kidney transplant recipients treated in a Dutch university hospital. Directed content analysis (DCA) was used.RESULTSForty-one kidney transplant recipients participated. Challenges after transplantation included becoming an expert patient, adjusting daily life activities, dealing with medical regimen, forming relationships with nurses, dealing with social consequences, dealing with emotions related to transplantation and the donor and improving self-image. To be able to deal with these challenges, participants wished to receive disease specific knowledge and instruction, share personal experiences with fellow patients, share and discuss not only medical but also emotional and social issues with nurses and wanted to be encouraged through positive feedback. "One-size fits all" education was considered insufficient in meeting their needs.CONCLUSIONSAfter kidney transplantation, recipients experienced various challenges in dealing with the medical, emotional and social tasks. Current support from nurses overlooked recipients' emotional and social support needs. Nurses need adequate tools and training to be able to meet recipients' self-management support needs.

Patienten reizen wereldwijd voor niertransplantaties. Zorgverleners in Nederland krijgen te maken met deze patienten, voor en na de transplantatie. Wij presenteren de resultaten van een enquete onder Nederlandse transplantatieprofessionals over hun ervaring met patienten die in het buitenland zijn getransplanteerd. Vervolgens beargumenteren wij dat zorgverleners illegale transplantaties zouden moeten rapporteren. 100 van de 241 ondervraagde professionals behandelden patienten die buiten de EU waren getransplanteerd: 31 professionals wisten zeker dat de nier gekocht was en 65 hadden vermoedens. De meerderheid ervoer een conflict van plichten. Zorgverleners kunnen een rol spelen bij het signaleren en melden van orgaanhandelnetwerken. Het doel van het melden is tweeledig. Ten eerste kan deze informatie leiden tot meer kennis over de werkwijze van orgaanhandelaren. Ten tweede kunnen politie- en justitiediensten onderzoeken of daadwerkelijk een crimineel netwerk is betrokken bij het faciliteren van deze transplantaties. Op deze manier kunnen degenen worden berecht die orgaanhandel faciliteren, zodat uitbuiting van donoren wordt voorkomen. Orgaanhandel komt overal in de wereld voor. Steeds vaker verschijnen er berichten over arme donoren die hun nier op de zwarte markt verkopen. Volgens deze berichten verkopen zij hun nieren veelal aan buitenlandse patienten.1,2 Onlangs bleek uit een systematische literatuurstudie dat van ruim 6000 patienten gerapporteerd is dat zij tussen 1970 en 2013 naar een ander land reisden voor een orgaantransplantatie.3 De meest genoemde transplantaties betroffen levende nierdonaties van genetisch niet-verwante donoren. China, Pakistan en India waren de populairste bestemmingslanden. Er wordt meestal verondersteld dat deze patienten hun nier hebben verkregen van donoren die daarvoor zijn betaald of uitgebuit. Patienten die in het buitenland zijn getransplanteerd lopen een significant hoger risico op infectie en afstoting dan patienten die binnen de landsgrenzen zijn getransplanteerd.

Introduction Worldwide, tens of thousands of healthy individuals participate in living kidney donation programs to help patients with end-stage renal disease. Potential living donors are exhaustively screened by transplant professionals, who select only those whose health will not be compromised by donation. The past years, single-center and national registry studies on long-term follow-up outcomes comparing donors to non-donors have reported unfavourable results. Methods We conducted a follow-up study of 761 living kidney donors from The Netherlands using individual level donor data who were propensity-score matched with 1522 non-donors from two Western population-based cohort studies on age, gender, BMI, ethnicity, kidney function, blood pressure, pre-existing co-morbidity, smoking, alcohol use and highest education degree. Live kidney donations occurred between 1981 through 2010 with follow-up until April 20th, 2016. All data were obtained from self-reporting, interview-based questionnaires, physical examination, and laboratory tests. The median follow-up time after donation was 8.0 years. The primary outcome was kidney function as defined by creatinine level and eGFR (as measured by CKD-Epi formula) at follow-up. Results One-year median eGFR was 59.0 ml/min/1.73 m2 (IQR 50.5-68.6 ml/min/1.73 m2) and eGFR at follow-up was 59.9 ml/min/1.73 m2 (IQR 51.4-70.7 ml/min/1.73 m2). Donors were found to have an increased serum creatinine of 26.03 μmol/l (95%CI 24.17; 27.89), a decreased eGFR of 27.23 ml/min/1.73m2 (95%CI -28.61; -25.85), and eGFR decline of 31.70% (95%CI 29.94-33.46) as compared to non-donors at follow-up. There was no difference in outcome between donors and non-donors for ESRD, microalbuminuria, BMI, incidence of diabetes or cardiovascular events, and cardiovascular mortality. A lower risk of new-onset hypertension (OR 0.45, 95%CI 0.33; 0.62) was found among donors. The EQ-5D health-related quality of life was higher among donors, while the SF-12 physical and mental component scores were lower. Conclusion In conclusion, one year after donation live donors have a reduced renal function, remaining stable without any kidney-related morbidity or mortality to at least eight years of follow-up. However, the decline in renal function may be further compromised when unforeseen conditions would develop that additionally affect renal function. Having knowledge of this risk, albeit small, donors should be well-informed by the medical team and offered lifelong follow-up to monitor the remnant renal function. Nierstichting Nederland. Stichting Coolsingel. Fonds NutsOhra.