A new population-based, cohort study from London Health Sciences Centre Research Institute (LHSCRI), Western University, and ICES, found that living male kidney donors have a higher chance of developing a scrotal condition called a scrotal hydrocele, which is when an area around the testicle swells with fluid, causing discomfort which may require surgery to ease. The scrotal hydroceles were found to occur on the same side as the donated kidney.
Now published in Annals of Internal Medicine, the research team analyzed health data from nearly 900 male donors in Ontario and 9,000 male non-donors with similar baseline characteristics. They found that one in eight male donors went on to have scrotal surgery over 20 years, compared to only one in 143 non-donors.
Patients receiving kidneys are often in need of the organ because dialysis treatments, which remove toxins from the blood, are not as effective as a healthy kidney. Even with regular dialysis, the average life expectancy is about five years. In contrast, a kidney transplant can dramatically improve both quality of life and survival, helping patients live longer and more independently.
In his clinical practice, Dr. Garg noticed several former male donors reporting scrotal swelling and pain on the same side as their donated kidney, years after the donation procedure, which prompted further investigation.
“One donor started wearing a support at night and could no longer run marathons because of his discomfort while another shared that they could no longer ride a bicycle,” says Dr. Garg, Scientist at LHSCRI, Nephrologist at London Health Sciences Centre (LHSC), Professor of Medicine and Epidemiology and Biostatistics at Western, and Lead of the ICES provincial Program in Kidney, Dialysis and Transplantation.
The usual treatment for a painful hydrocele is a hydrocelectomy, a brief day surgery; recovery is typically a few weeks before returning to normal activities.
The study used records made available through ICES, an independent research institute that manages Ontario’s comprehensive health-care databases. Several team members participate in a provincial program which uses ICES data to enhance kidney, dialysis, and transplantation care.
“Thanks to a team experienced in the use of population-based health records, we pursued a clinical observation quickly and rigorously,” says Garg.
While the study brings attention to this connection, LHSC experts emphasize that living kidney donation remains a life-saving act that transforms lives. The team stresses that this new insight should inform better screening, counselling, and follow-up care, not discourage donation.
Living kidney donation is now performed in 91 countries with about 40,000 surgeries done each year globally.
“Most males who donate a kidney won’t develop scrotal hydroceles, so it shouldn’t discourage donation,” says Garg. “Kidney transplantation is life-changing for the five million people worldwide with kidney failure, helping patients live longer and better at far lower costs than dialysis. Yet many are unable to receive a transplant because deceased-donor organs are scarce. Living donation can bridge the gap, offering shorter waits, better outcomes, and lower costs.”
According to the Canadian Institute for Health Information (CIHI), just over half of living organ donations come from related donors.
“The males who developed scrotal hydroceles in my practice all had a connection to the donor, whether it was a family member or friend. In every case, the living kidney donor who received scrotal surgery said they would donate again,” says Garg.
The study hopes to support transplant counselling worldwide and be incorporated into new practice guidelines. It is also inspiring new research at LHSCRI into surgical techniques that might reduce the chance of developing this condition.
“We’ve now added a baseline scrotal ultrasound as part of a process to evaluate potential kidney donors in London, Ontario,” says Garg. “This will serve as a reference if a health condition develops after donation. Our goal is to better inform donors and improve their long-term care. We counsel them on symptoms they may experience so they can monitor themselves after donation.”
The study was funded by the Canadian Institutes of Health Research (CIHR).
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