Outcomes of living related kidney donors of recipients with familial mediterranean fever-associated Amyloid A Amyloidosis

Abstract

BACKGROUND: Living kidney donation among carefully selected individuals is generally considered safe but post-donation health risks vary by factors including family history. Data on long-term outcomes of related living kidney donors of recipients with familial Mediterranean fever (FMFLRD) are limited. METHODS: This retrospective multicenter study reviewed the medical records of living donors who donated between 2010 and 2021 across six transplantation centers. Cardiovascular and kidney outcomes were compared between 37 FMFLRD and a propensity-matched control group of 74 donors to recipients without FMF (non-FMFLRD). Propensity score matching was based on donor age, sex, and follow-up time. Outcome measures included major cardiac events (MACE), new-onset hypertension, new-onset diabetes mellitus, proteinuria and estimated glomerular filtration rate (eGFR). RESULTS: The median follow-up duration of all donors was 4.0 years (interquartile range, IQR 2.0-11.0 years). The mean age of the FMFLRD group was 48.9 ± 9.3 years, The FMFLRD group showed a significantly lower proportion of MACE (2.7% vs. 17.6%, p = 0.026) and new-onset hypertension (13.5% vs. 39.2%, p = 0.004) and a trend towards a lower proportion of new-onset diabetes mellitus (2.7% vs. 14.9%, p = 0.052) compared to the non-FMFLRD group. There were no significant differences in long-term kidney function, as evidenced by similar eGFR and proteinuria levels between the groups. CONCLUSION: The FMFLRD group showed similar kidney outcomes and lower rates of cardiovascular and metabolic complications during follow-up compared with matched non-FMFLRD; however, given the retrospective design and relatively short follow-up duration, long-term donor safety remains uncertain and the results should be interpreted cautiously.