Living kidney donors: the need to minimise long term risk.

Living kidney donor (LKD) transplantation is an important option for people with established renal disease and their families. Outcome data for donors shows that it is a relatively safe procedure. Long-term studies do not take into account the wider acceptance criteria currently employed, or the increasing number of ethnic minority donors. A literature review was carried out to look for evidence that the risk to donors should be reassessed in order to be able to inform donors better about those risks and whether they are modifiable. Strong evidence was found that LKD has good short-term outcomes; long-term evidence is incomplete in view of the selection criteria currently used for donors and lack of studies. LKD remains a low risk procedure and should continue to be encouraged. However, evaluation of donors should be more thorough with particular respect to any long-term risk of diabetes mellitus and other cardiovascular risk factors related to family or ethnic disposition and lifestyle. Long-term surveillance is essential to modify risk factors, allow early intervention and to further develop evaluation criteria.