The mortality risk was equal in the two groups by day 106 of follow-up, and improved in the transplanted group thereafter. McDonald and Russ have reported similar findings using ANZDATA.14 An analysis of the period 1991–2000 found an 80% lower long-term risk of mortality between those transplanted and those remaining on the waiting list. Cameron et al. have performed a meta-analysis examining

the effect of transplantation on overall quality of life.15 Successful kidney transplantation was associated with improved BMS-777607 general wellbeing and less distress, when compared with continued haemodialysis or peritoneal dialysis. There are several individual studies that have examined quality of life issues in more detail. Evans et al. reported that 79.1% of transplant recipients describe near normal physical function, compared with only 50% of dialysis patients.16 Mental function scores were also higher in transplant recipients. Studies by both Gorlen et al.17 and Laupacis et al.18 found that the quality of life improvements associated with transplantation were sustained long term. However, transplantation continued to affect quality of life relative to normal.18 This was attributed to the side effects of immunosuppression,

comorbid conditions and the stress associated with the possibility of losing graft function. A detailed analysis of the relative costs of SB-3CT dialysis and PLX4032 in vitro transplantation has been performed by Kidney Health Australia.19 Estimates of the cost of home or satellite-based dialysis (haemodialysis and peritoneal) for an individual are approximately $45 000–$60 000 per year. Hospital-based haemodialysis is estimated to cost approximately $83 000 per year. Although the initial cost of transplanting an individual is estimated to be relatively high ($62 000 for the first year) the cost falls significantly thereafter (approximately $11 000 per year for year 2 and onwards). The estimated costs associated

with an individual live donor transplant are similar to those for an individual deceased donor transplant.19 A Canadian report estimated that transplanting an individual would result in savings of CAN$104 000 over a 20-year period.20 Only a brief account of the overall safety data will be summarized here. A much more detailed analysis of the literature regarding donor safety will follow in subsequent sections of these Living Kidney Donor guidelines. By and large, live kidney donation is considered to be safe for the majority of healthy donors. This contention, however, is based predominantly on large retrospective studies, which demonstrate that unilateral nephrectomy in healthy subjects is generally associated with a very low level of long-term risk.21–27 A meta-analysis published by Garg et al. has examined the development of proteinuria in donors.