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American Journal of Transplantation 2015; 15: 286 Wiley Periodicals Inc.

Copyright 2014 The American Society of Transplantation and the American Society of Transplant Surgeons doi: 10.1111/ajt.13016

Letter to the Editor

Selecting Appropriate Controls for Kidney Donors To the Editor: We read with great interest the recent study by Reese et al (1) regarding outcomes in older living donors. Accurate estimates of long-term risks in donors are essential for adequate selection and follow-up. The most important of these is the risk of all-cause mortality. As in any study concerning long-term survival, the most critical factor is if the control group is healthy enough to serve as comparators for kidney donors. Living kidney donors are thoroughly assessed by physical examination, biochemical testing and radiology. As the authors themselves state (1) such information was not available for the control group. In fact, comorbidities were only ascertained through interviews. This may not have been sufficient. In this article, the survival curve for all-cause mortality separates immediately after donation in favor of donors. This would imply that, if the groups were indeed similar at baseline, nephrectomy would be associated with an immediate improvement in survival among donors. From what is known about the risks of major surgery and removal of organs, this is not a likely explanation. More likely, the immediate separation of survival curves is due to the fact that the donors are healthier at baseline than the control group. We suspect that if more information regarding health status at baseline had been available, this would have improved the selection of controls, probably resulting in a healthier control

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group with better long-term survival. This could have resulted in other survival curves and other conclusions. The authors conclude at the end of the abstract that ‘‘carefully selected older kidney donors do not face a higher risk of death or CVD’’ (p. 1853). As long as the control group is not also carefully selected, we fear that such a conclusion is premature. G. Mjøen1, and H. Holdaas2 Department of Nephrology, Oslo University Hospital, Oslo, Norway 2 Department of Transplantation, Oslo University Hospital, Oslo, Norway  Corresponding author: Geir Mjøen, [email protected] 1

Disclosure The authors of this manuscript have no conflicts of interest to disclose as described by the American Journal of Transplantation.

Reference 1. Reese PP, Bloom RD, Feldman HI, et al. Mortality and cardiovascular disease among older live kidney donors. Am J Transplant 2014; 14: 1853–1861.

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