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Outcomes after kidney donation--reply.

P values and confidence intervals fully account for the technique we used. Matas and colleagues also misinterpreted our lifetime risk calculation, inferring that the lifetime ESRD risk of “healthy controls younger than 30 years was 0 per 10 000” rather than that ESRD risk by age 30 was 0 per 10 000 controls who entered the risk set prior to that age. Drs Kiberd and Tennankore suggest that our method of splicing together early follow-up intervals to estimate lifetime risks might have resulted in underestimation of risk. We agree that estimating lifetime risk of ESRD based on 15-year follow-up in different age cohorts is an approximation; unfortunately, it will be decades before we have follow-up long enough for better lifetime estimates. We also agree that cumulative risk will vary by donor characteristics; our cumulative risk estimates should only be interpreted as averages. Of 3 groups of researchers, 2 believe we have overestimated and 1 believes we have underestimated donor risk of ESRD. We disagree with several concerns raised about our methods, and we hope we have clarified these. We agree that our findings should not discourage kidney donation because the risks remain very low. However, better understanding and quantifying risk associated with donation remain a priority.