Incidence of Malignancy in Post-Donation Living Kidney Donors: A Single-Center, Retrospective Cohort Study in Japan.

Aim: Long-term health outcomes in living kidney donors (LKDs) are generally favourable. However, recent studies suggest a slightly increased malignancy risk when compared to the general healthy population. Malignancies are influenced by environmental and racial factors; nonetheless, descriptive epidemiological studies on malignancy incidence in LKDs in Asia are lacking. In this study, we aimed to investigate the incidence and characteristics of post-donation malignancies in LKDs.

Methods: This retrospective observational study included 196 LKDs who underwent nephrectomies between 2008 and 2023. LKDs were categorised into new-onset malignancy and non-malignancy cohorts. Postoperative malignancy surveillance combined population-based cancer screenings, employer-sponsored health examinations, self-paid health checkups, and active surveillance. Baseline characteristics, cancer types, outcomes, and the correlation between cancer incidence and postoperative albuminuria were analysed.

Results: Eighteen LKDs (9.2%) developed malignancies over a mean follow-up of 6.7 ± 4.1 years, with an incidence rate of 13.6 per 1000 person-years. The most common cancers were gastric, colorectal, and prostate. Malignancy was more frequent in older donors, males, and those with postoperative hypertension. Most cases were detected at an early stage, allowing curative treatment. The most common diagnostic category of cancer identified was performed as part of our institution's active surveillance. No notable correlation was observed between albuminuria and cancer incidence.

Conclusion: While some LKDs developed post-donation malignancies, appropriate and balanced cancer surveillance is essential in managing LKDs, in whom the principle of "do no harm" must be upheld. Establishing a structured system, including public screening programmes and LKD-specific surveillance, would help ensure donor safety and long-term health.