Implications of excess weight on kidney donation: Long-term consequences of donor nephrectomy in obese donors

Background: An elevated body mass index (>30 kg/m ² ) has been a relative contraindication for living kidney donation; however, such donors have become more common. Given the association between obesity and development of diabetes, hypertension, and end-stage renal disease, there is concern about the long-term health of obese donors. Methods: Donor and recipient demographics, intraoperative parameters, complications, and short- and long-term outcomes were compared between contemporaneous donors—obese donors (body mass index ≥30 kg/m ² ) versus nonobese donors (body mass index <30 kg/m ² ). Results: Between the years 1975 and 2014, we performed 3,752 donor nephrectomies; 656 (17.5%) were obese donors. On univariate analysis, obese donors were more likely to be older (P <.01) and African American (P <.01) and were less likely to be a smoker at the time of donation (P =.01). Estimated glomerular filtration rate at donation was higher in obese donors (115 ± 36 mL/min/1.73m ² ) versus nonobese donors (97 ± 22 mL/min/1.73m ² ; P <.001). There was no difference between groups in intraoperative and postoperative complications; but intraoperative time was longer for obese donors (adjusted P <.001). Adjusted postoperative length of stay (LOS) was longer (adjusted P =.01), but after adjustment for donation year, incision type, age, sex, and race, there were no differences in short-term (<30 days) and long-term (>30 days) readmissions. Estimated glomerular filtration rate and rates of end-stage renal disease were not significantly different between donor groups >20 years after donation (P =.71). However, long-term development of diabetes mellitus (adjusted hazard ratio (HR) 3.14; P <.001) and hypertension (adjusted hazard ratio (HR) 1.75; P <.001) was greater among obese donors and both occurred earlier (diabetes mellitus: 12 vs 18 years postnephrectomy; hypertension: 11 vs 15 years). Conclusion: Obese donors develop diabetes mellitus and hypertension more frequently and earlier than nonobese donors after donation, raising concerns about increased rates of end-stage renal disease.