EDITORIAL COMMENT

The authors have investigated the perioperative complications after donor nephrectomy integrating the US transplant registry with administrative records from an academic hospital consortium (97 centers, 2008-2012). 14.964 patients were verified as live donors through linkage with the Organ Procurement and Transplantation Network registry. Overall, 16.8% of donors experienced a perioperative complication, including Clavien grade 2 or higher events in 8.8%, Clavien grade 3 or higher in 7.3%, and Clavien grade 4 or higher events in 2.5%. The most common complications were gastrointestinal (4.4%), bleeding (3.0%), respiratory (2.5%), and surgical/anesthesia-related injuries (2.4%). After adjustment for demographic and clinical factors, African American donors were 26% more likely to experience any perioperative complication and 56% more likely to experience the most severe complications. Other factors associated with increased risk of any perioperative complication, and with the most severe complications included predonation hematologic and psychiatric conditions and more recent years of donation. Donation at centers with the highest annual volume of living donor nephrectomies (>50 cases/year) was associated with approximately 45% lower risk of any perioperative complication and of the most severe complications. Donors who underwent robotic nephrectomy were twice as likely to experience severe perioperative complications (adjusted odds ratio 2.07 for Clavien grade 4 or higher events). To conclude, the authors found that while one in six US living kidney donors experienced a perioperative complication, the most severe complications were infrequent, affecting only 2.5% of donors.