Pain expectancy, prevalence, severity, and patterns following donor nephrectomy: Findings from the KDOC Study

• Published in: American journal of transplantation Vol. 20; no. 9; pp. 2522 - 2529
• Main Authors: Fleishman, Aaron, Khwaja, Khalid, Schold, Jesse D., Comer, Carly D., Morrissey, Paul, Whiting, James, Vella, John, Kayler, Liise K., Katz, Daniel, Jones, Jody, Kaplan, Bruce, Pavlakis, Martha, Mandelbrot, Didier A., Rodrigue, James R.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01-09-2020
• Subjects: anesthesia/pain management; Blood & organ donations; Chronic pain; clinical research/practice; donors and donation; donors and donation: donor follow‐up; donors and donation: living; Expectancy; Follow-Up Studies; Health psychology; health services and outcomes research; Humans; Kidney Transplantation - adverse effects; kidney transplantation/nephrology; kidney transplantation:living donor; Kidney transplants; Living Donors; Mood; Nephrectomy; Nephrectomy - adverse effects; Organ donors; Pain; Pain, Postoperative - epidemiology; Pain, Postoperative - etiology; Postoperative period; Prevalence; quality of life (QOL); donors and donation: living; quality of life (QOL); donors and donation: donor follow-up; anesthesia/pain management; clinical research/practice; kidney transplantation/nephrology; kidney transplantation:living donor; donors and donation; health services and outcomes research
• ISSN: 1600-6135; 1600-6143
• DOI: 10.1111/ajt.15861

Postoperative pain is an outcome of importance to potential living kidney donors (LKDs). We prospectively characterized the prevalence, severity, and patterns of acute or chronic postoperative pain in 193 LKDs at six transplant programs. Three pain measurements were obtained from donors on postoperative Day (POD) 1, 3, 7, 14, 21, 28, 35, 41, 49, and 56. The median pain rating total was highest on POD1 and declined from each assessment to the next until reaching a median pain‐free score of 0 on POD49. In generalized linear mixed‐model analysis, the mean pain score decreased at each pain assessment compared to the POD3 assessment. Pre‐donation history of mood disorder (adjusted ratio of means [95% confidence interval (CI)]: 1.40 [0.99, 1.98]), reporting “severe” on any POD1 pain descriptors (adjusted ratio of means [95% CI]: 1.47 [1.12, 1.93]) and open nephrectomy (adjusted ratio of means [95% CI]: 2.61 [1.03, 6.62]) were associated with higher pain scores across time. Of the 179 LKDs who completed the final pain assessment, 74 (41%) met criteria for chronic postsurgical pain (CPSP), that is, any donation‐related pain on POD56. Study findings have potential implications for LKD education, surgical consent, postdonation care, and outcome measurements.
This prospective, multicenter study to assess pain following living kidney donation reports that many donors experience prolonged postsurgical pain and that predonation history of mood disorder, early severe postoperative pain, and open nephrectomy were associated with higher pain scores.