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MP59-13 KIDNEY TRANSPLANT IN PATIENTS UNDER WARFARIN USE: DOES IT INCREASE THE RISKS? ANALYSIS OF OUTCOMES AND COMPLICATIONS

INTRODUCTION AND OBJECTIVE: Live donor nephrectomy (DN) is a safe and effective procedure for altruistic patients to give a kidney to others suffering from end stage renal disease (ESRD). Previous studies have shown a short-term complication rate of up to 10% and no increased risk for long-term complications. We aimed to characterize the specific long-term medical and surgical outcomes of DN. METHODS: We performed a population-based cohort study using the New York Statewide Planning and Research Cooperative System (SPARCS) database. Using ICD-9 codes, patients who underwent DN between 1995 and 2004 were identified and tracked for incidence of new medical issues (acute kidney injury [AKI], chronic kidney disease [CKD], ESRD or hypertension [HTN]) and new surgical issues (hernia repair or bowel obstruction) for 10 years following surgery. Healthy controls were selected from the SPARCS and propensity score matched for analysis based on age, sex, race, and location. Multivariable logistic regression was performed in the propensity-matched cohort. RESULTS: 3773 DN cases were identified for analysis and 3770 controls were selected via propensity score matching. 88% of the cases were open approach and 12% were laparoscopic. The overall 10year incidence rate of CKD was 1.25%, HTN was 9.51%, hernia was 1.43%, and bowel obstruction was 1.91% (Table 1). DN patients had an increased risk of bowel obstruction compared to controls (OR 1.50, 95% CI 1.01-2.23). Overall, DN patients had an increased risk of undergoing a hernia repair compared to controls (OR 3.70, 95% CI 1.92e7.14). DN patients had lower rates of medical issues including decreased risk of AKI (OR 0.60, 95% CI 0.43-0.84), mild to moderate CKD (OR 0.22, 95% CI 0.09-0.51), primary HTN (OR 0.55, 95% CI 0.47-0.65), and HTN with cardiac disease (OR 0.45, 95% CI 0.211.00). Other forms of HTN, severe CKD and ESRD were not significantly different from controls.Table 1 CONCLUSIONS: This study suggests that live kidney donors show improved long-term medical outcomes but poorer surgical outcomes over controls. Selection bias of healthy patients is inherent to live kidney donation, and these patients seem to remain healthier than the general population well after DN. These findings can be used to counsel and encourage future donors on the safety of undergoing DN.