When the kidney donor has been thoroughly examined according to the usual standards [1], complications in the short and the long term are seldom seen. This, together with the favourable outcome for the recipient, justifies living donor transplantation.
However, a presumed complication could have been fatal to a 63-year-old woman who donated her right kidney to her brother in January 2003. In the following May and June, she had severe pain in the left flank and, when vomiting, general oedema and ultimately anuria occurred, she was admitted to the urological department, where the serum level of creatinine was found to be 841 µmol/l. Ultrasound showed hydronephrosis and, after nephrostomy, the serum creatinine dropped to 150 µmol/l. Antegrade pyelography revealed no stones or stricture and the catheter was removed. Unfortunately, the patient was readmitted with similar symptoms some weeks later. Nephrostomy was again performed and no abnormalities in the urinary tract were seen on the pyelogram. The woman had had no problems whatsoever from the urinary tract before donation, and hydronephrosis of the kind caused by a valvular effect over an aberrant artery passing the ureteropelvine junction was suspected. After a period with a JJ stent, she underwent a pyeloplastic operation in August, and 1 year after donation was well with a serum creatinine of 123 µmol/l.
Before donation, the patient reduced her weight from 102 to 79 kg to achieve a body mass index (BMI) of 31. Intravenous pyelography showed a small extrarenal pelvis on the left side, which expert radiologists judged to be completely normal, as was the renogram. Arteriography showed two arteries on the left side.
The 65-year-old recipient had no urological complications, and 1 year after transplantation his serum creatinine was 142 µmol/l.
This kidney donor, who developed acute uraemia 5 months after donation, was at first believed to have passed a stone unknowingly. After a second similar episode with no stone or abnormalities in the urinary tract, another less obvious explanation had to be sought. She was used to drinking about four litres a day; all urine had to pass through one kidney, and it was suspected that a slight hydronephrosis was kinked over the aberrant artery, permitting complete obstruction now that surplus water could not be eliminated by a second kidney [2]. The weight loss with a decrease in the surrounding fatty capsule may have resulted in less physical support for the kidney, thus adding to the problem.
In any case, although kidney donors have a life expectancy longer than that of the general population and should not, in our opinion, have limitations set on their lives [3], health personnel, including physicians in primary care, must be very thorough in their diagnostic work-ups, when a person with a single kidney presents with symptoms from that region. Obstruction might have caused serious damage to the remaining kidney within a relatively short time.
We do not think that this potential complication has a frequency that should lead to limitation of kidney donation. However, when the remaining kidney has multiple vessels and an extrarenal pelvis, the risk of ureteropelvic junction obstruction may be slightly increased [4,5].
Conflict of interest statement. None declared.
1 Department of Nephrology Odense University Hospital DK-5000 Odense C2 Department of Urology Skejby Hospital DK-8200 Aarhus N Denmark Email: bjesper{at}dadlnet.dk
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