Slower recovery from kidney removal for donors

NEW YORK Thu Sep 23, 2010 1:54pm EDT

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NEW YORK (Reuters Health) - People who have a healthy kidney removed in order to donate may take a bit longer to fully recover than people who have the surgery due to kidney disease, a new study suggests. Expectations may play an important role in the differences.

The research involving 149 patients at one Canadian medical center looked at how quickly patients recuperated physically and how fast they returned to their pre-surgery quality of life after undergoing laparoscopic, or "key-hole," surgery to remove a kidney.

Participants filled-in questionnaires, before and after surgery, to assess, among other things, their "health-related quality of life" - including factors like pain, ability to perform routine daily activities and mental well-being.

Little has been known about the rate at which patients typically regain their quality of life after kidney removal, whether through traditional open surgery or laparoscopy -- where a surgeon uses several small incisions and thin instruments to perform the procedure.

In the new study, researchers found that overall, patients who were younger than 50, had a lower body mass index (BMI) or were physically active before surgery tended to bounce back more quickly both physically and mentally.

But that was less true of the 95 patients who were kidney donors.

"The donors still recovered very well," explained senior researcher Dr. Kenneth T. Pace, of St. Michael's Hospital and the University of Toronto in Canada. "But a young, fit and slim donor took slightly longer to recover than the same-aged, same activity (level), same BMI non-donor patient."

The findings should not discourage people from becoming kidney donors, Pace told Reuters Health in an e-mail. Instead, they help give prospective patients an idea of what to expect during recovery.

The study, reported in the urology journal BJU International, included a series of patients who underwent laparoscopic kidney removal at the researchers' center between 2004 and 2008. Ninety-five were kidney donors; 12 had what is called a simple nephrectomy, where an entire kidney is removed; and 42 had a radical nephrectomy, where the surgeon removes a whole kidney plus surrounding tissue, such as the neighboring adrenal gland and nearby lymph nodes.

Patients in the radical nephrectomy group were being treated for earlier stage cancer that had not spread to distant sites. The simple nephrectomies were performed to remove a non-functioning kidney.

All of the patients completed a standard questionnaire on health-related quality of life two weeks before surgery, and then periodically over 16 weeks following surgery.

Overall, Pace's team found, non-donor patients typically needed 53 days to return to 75 percent of their original score on the quality-of-life measure, and 90 days to get back to 90 percent. For donors, those figures were 62 days and 110 days, respectively.

Patients under 50 were twice as likely as their older counterparts to return to 75 percent of their baseline score within 60 days of surgery. Similarly, patients who were not obese were 70 percent more likely to make such a comeback as heavier patients. And those who were physically active before surgery had a 30 percent greater chance of a speedier recovery than sedentary patients.

Since kidney donors as a group are generally younger, fitter and healthier than those with kidney disease, it is not fully clear why donors in this study had a somewhat slower recovery. But psychological factors may be at work, according to Pace and his colleagues.

Healthy donors are likely to have had a better pre-surgery quality of life than those having a diseased organ removed, and afterwards, the sick patients may be more focused on the relief the surgery provides.

In general, Pace noted, donors "are very high functioning to begin with and have often never had surgery, and so have high expectations for their post-operative recovery." So they may, compared with non-donors, give lower ratings to their quality of life soon after surgery.

Pace also pointed out while non-donors may focus on immediate benefits like pain relief or the knowledge that their cancer has been removed, donors get no physical gain from the surgery. (They may feel good about donating, he noted, but this was not measured in the study.)

The study has limitations, including the fact that it was based on patients at a single, busy academic medical center. It is not clear how widely applicable the findings might be.

But, the researchers write, the results offer some insight into the factors that matter in patients' recovery time.

Pace said he and his colleagues now try to address the gap between donors and non-donors by giving prospective surgery patients a more detailed description of their expected recovery.

SOURCE: link.reuters.com/fuj25p BJU International, online August 26, 2010.

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