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

Authors

Aaron Fleishman, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Khalid Khwaja, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Jesse D. Schold, Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH, USA.
Carly D. Comer, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Paul Morrissey, Transplant Center, Rhode Island Hospital, Providence, RI, USA.
James Whiting, Maine Transplant Center, Maine Medical Center, Portland, ME, USA.
John Vella, Maine Transplant Center, Maine Medical Center, Portland, ME, USA.
Liise K. Kayler, Montefiore Einstein Center for Transplantation, Bronx, NY, USA.
Daniel Katz, Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Jody Jones, Organ Transplantation Program, University of Iowa Hospitals and Clinics, Iowa City, IA, USA.
Bruce Kaplan, Baylor Scott and White Health, Temple, TX, USA.
Martha Pavlakis, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Didier A. Mandelbrot, Department of Medicine, University of Wisconsin, Madison, WI, USA.
James R. Rodrigue, The Transplant Institute, Beth Israel Deaconess Medical Center, Boston, MA, USA.

Document Type

Article

Publication Date

9-2020

Institution/Department

Nephrology & Transplantation

Journal Title

American journal of transplantation : official journal of the American Society of Transplantation and the American Society of Transplant Surgeons

MeSH Headings

Follow-Up Studies; Humans; Kidney Transplantation (adverse effects); Living Donors; Nephrectomy (adverse effects); Pain, Postoperative (epidemiology, etiology); Prevalence

Abstract

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.

First Page

2522

Last Page

2529

Recommended Citation

Fleishman A, Khwaja K, Schold JD, et al. Pain expectancy, prevalence, severity, and patterns following donor nephrectomy: Findings from the KDOC Study. Am J Transplant. 2020;20(9):2522-2529. doi:10.1111/ajt.15861