Medical outcomes of adolescent live kidney donors MacDonald D, Kukla AK, Ake S, Berglund D, Jackson S, Issa N, Spong R, Matas AJ, Ibrahim HN. Medical outcomes of adolescent live kidney donors. Abstract: Living kidney donation from donors <18 yr of age is uncommon. The majority of donations from adolescents took place several decades ago providing a unique opportunity to study true long- term consequences of donation. We compared survival, renal outcomes, and rates of hypertension and diabetes among 42 adolescent donors and matched older controls. Adolescent donors were matched with donors 18–30 yr on the following: gender, relation to the recipient, BMI at donation, eGFR at donation, and year of donation. After a mean follow-up of 31.8 Æ 8.0 yr, 94.9% of adolescent donors were alive vs. 93.8% of controls. There was no significant difference in having eGFR (MDRD) <60 mL/min/1.73 m 2 (26.1% vs. 40.9%), hypertension (35.9% vs. 39.4%), diabetes (5.1% vs. 12.5%), or proteinuria (15.4% vs. 14.1%): adolescent donors vs. controls for all comparisons. These data suggest that adolescent donors are not at a higher risk of shortened survival, hypertension, diabetes, or proteinuria. Nevertheless, they probably should donate only when other options are exhausted as they have to live with a single kidney for decades and longer follow-up is needed. David MacDonald 1 , Aleksandra K. Kukla 1 , Sarah Ake 1 , Danielle Berglund 2 , Scott Jackson 1 , Naim Issa 1 , Richard Spong 1 , Arthur J. Matas 2 and Hassan N. Ibrahim 1 1 Division of Renal Diseases and Hypertension, University of Minnesota, Minneapolis,MN, USA, 2 Department of Surgery, University of Minnesota, Minneapolis, MN, USA Key words: adolescent – donor – kidney – glomerular filtration rate – hypertension – diabetes mellitus – proteinuria Hassan N. Ibrahim, MD, MS, Professor of Medicine, Director, Division of Renal Diseases and Hypertension, University of Minnesota, 717 Delaware St. SE, Suite 353, MDC 1932, Minneapolis, MN 55414, USA Tel.: +1 612 624 9930 Fax: +1 612 626 3840 E-mail: ibrah007@umn.edu Accepted for publication 24 January 2014 Living donor kidney transplants are rarely per- formed using donors <18 yr of age. In fact, between 1987 and 2000, of approximately 40 000 US live kidney donors, 60 were <18 yr of age and only seven such donations took place between 2001 and 2012. Donations involving adolescent donors are typically performed between HLA identical individuals, fraternal twins, or from mothers to their infants (1). Adult kidney donors appear to have similar life span, kidney function, and quality of life to that of non-donors (2, 3). There are no data, however, on how adolescent donors fare relative to older kidney donors. Young children who undergo nephrectomy for non-malignant reasons gener- ally do well (4–6). Concerns, however, remain about outcomes among young kidney donors and young patients who undergo unilateral nephrec- tomy for medical reasons as they have to contend with the potential consequences of reduced renal mass for decades, and current data are limited by the duration of their short follow-up. While most, if not all, transplant centers in the US do not currently accept adolescent donors, it is legally possible for some young people to donate organs in other countries (7). There have been 42 such donors at the University of Minne- sota: eight donated more than 40 yr ago, 28 donated 30–40 yr ago, five donated 20–30 yr ago, and the most recent donation took place in 1996. This unique cohort offers an unprece- dented opportunity to study the consequences of unilateral nephrectomy in healthy adolescents 3– 4 decades after donation. Moreover, knowledge gained from this cohort may influence decision making for potential donors who are 18, 19, or even 25 yr old. Therefore, we matched adolescent donors with donors aged 18–30 at donation to determine whether adolescent donors incur increased risks of premature death, reduced GFR, proteinuria, hypertension, or diabetes. We hypothesized that adolescent donors do as well as other donors their senior. Abbreviations: AAP, American Academy of Pediatrics; AST, American Society of Transplantation; CKD, chronic kidney disease; DBP, diastolic blood pressure; eGFR, esti- mated GFR; ESRD, end-stage renal disease; GFR, glomer- ular filtration rate; MDRD, Modification of Diet in Renal Disease; SBP, systolic blood pressure. 336 Pediatr Transplantation 2014: 18: 336–341 © 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Pediatric Transplantation DOI: 10.1111/petr.12238