This scoping review aimed to explore the pain, quality of life, work ability and mental health of LKDs, with a focus on psychological aspects such as anxiety and depression.

This scoping review followed a protocol that was registered in advance on the Open Science Framework on December 4, 2023 (doi: 10.17605/OSF.IO/FPEQN). The review methodology was based on the framework outlined by the Joanna Briggs Institute (JBI).40 The study was reported according to the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews) guidelines.41,42

The PCC framework was used to formulate the research question. The Population (P) considered adult living kidney donors, the Concept (C) focused on kidney donation and associated outcomes such as pain, quality of life, work ability mental health, anxiety, and depression, while the Context (C) included both community and hospital settings.

The inclusion criteria were refined after a preliminary search of databases such as PubMed/Medline and Google Scholar. This scoping review included quantitative and primary studies that were available in full text. For inclusion, articles had to address the variables under investigation, namely pain, quality of life, or mental health of LKDs. Additional criteria encompassed studies conducted in both community and hospital settings and studies written in either Italian or English. Data extracted from the selected articles were analyzed based on the study objectives, sample characteristics, geographical context, and healthcare environment. There were no restrictions on the publication time frame. Studies that did not meet these criteria, as well as records such as books, editorials, conference papers, posters, secondary studies (reviews, meta-analyses), guidelines, studies on surgical techniques, pharmacological interventions, or economic aspects, were excluded. Only studies published in English or Italian were included due to the linguistic competence of the review team and the aim of ensuring accurate interpretation of results.

A comprehensive literature search was conducted across four databases: PubMed/Medline, Embase, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and the Cochrane Library, to identify relevant studies. The selected records were then imported into EndNote 20 software (accessible at https://endnote.com/), where duplicates were manually removed to ensure an accurate reference list for subsequent analysis.43 Search strings were developed using MeSH terms and relevant keywords, tailored for each database. The terms ‘donor,’ ‘living,’ ‘kidney,’ ‘quality of life’ and ‘work ability’ were selected based on the study's eligibility criteria. Google Scholar was consulted for grey literature to broaden the review. In line with the methodology adopted,40,42 reference lists and citations of full-text articles were screened for additional studies. Detailed search strings are provided in Supplementary File 1, ensuring transparency and reproducibility.

Two researchers (xx and xx) independently conducted the two-stage screening process, with conflicts resolved by a third author (MS), who was not involved in screening. In the first stage, titles and abstracts were reviewed, and studies involving non-CKD patients or those with incompatible designs were excluded. Articles with unclear population, intervention, or outcomes were also removed. This step efficiently filtered irrelevant studies, avoiding unnecessary full-text reviews. In the second stage, full texts of eligible records were retrieved using EndNote, internet searches, and journal access. The references and citations were reviewed to identify any additional relevant studies. During the final full-text screening, predefined inclusion and exclusion criteria were applied, leading to the exclusion of incorrect publication types and studies that did not address the pertinent variables.

The potential bias and methodological rigor of the selected studies were independently evaluated by two researchers (xx and xx) using the JBI critical appraisal checklists. In instances where discrepancies arose, a neutral third reviewer (xx) provided resolution. Studies were categorized based on quality, following criteria from a prior study,44 where those scoring above 70% on the JBI scale were considered high quality, scores between 50% and 70% were deemed medium quality, and those scoring below 50% were classified as low quality (Supplementary File 1).

The process was conducted by two researchers (xx and xx) to ensure a robust and unbiased approach. The results were reported in a table, extracting the following data: author, publication year, country, study design, sample size, aim, measurements used, main results, limits, and quality of study. The data were synthesized narratively, detailed in the text, and complemented by visual figures for clarity and integration.

Two studies,45,46 delve into the prevalence and characteristics of post-donation pain among LKDs, employing various questionnaires such as the McGill Pain Questionnaire (MPQ), Brief Pain Inventory (BPI), Leeds Assessment of Neuropathic Symptoms and Signs (S-LANSS), the Visual Analog Scale (VAS) and the Pain Rating Index (PRI-T) to assess pain levels and characteristics.

Bruintjes et al.46 focused on 512 LKDs, finding that 5.7% (29 patients) reported chronic pain following laparoscopic nephrectomy. A notable 12.2% prevalence of chronic pain was observed in patients 3–24 months’ post-surgery. Among these, 55.2% experienced mild pain and 34.5% severe pain. The pain was mostly continuous for 48.3% of the patients and intermittent for 37.9%, with common locations being the flank (25.0%), groin (18.2%), and supra-pubic area (15.9%). Pain severity was quantitatively assessed using the Visual Analogue Scale (VAS) (range 0–100) with an average score of 20 (±22), and the PRI-T (range 0–63), averaging at 10.21 (±9.06). Younger patients (age 35–39) reported higher pain intensity (p=0.01) than older patients (age 60–65). Among them, 27.6% needed pain relief medications like paracetamol or non-steroidal anti-inflammatory drugs, while one patient reported using tramadol. Owen et al.,45 on the other hand, studied 123 LKDs over a decade post-nephrectomy, with 66% (81 respondents) participating. Among these, 33% experienced chronic pain (over 3 months duration), and 26% suffered from chronic, surgery-related pain. Severe and disabling pain (score of ≥7 out of 10 using the Brief Pain Inventory) was reported by 48%, and neuropathic pain by 20%, based on the S-LANSS score (>12). Among those with chronic pain, a third required analgesia, which provided 41% relief on average; however, most relief was achieved through basic medications like ibuprofen, paracetamol, and codeine-based drugs.

Four studies47,51,52,54 investigated the mental health of LKDs using various assessment tools, including the World Health Organization Quality of Life brief version (WHOQOL-BREF), the Short Form Health Survey 36 (SF-36), the Hospital Anxiety and Depression Scale (HADS), and the Mental Component Summary (MCS). These studies primarily focused on measuring levels of anxiety, depression, and the overall psychological state of LKDs. The cross-sectional study by Shi et al.,51 evaluated 122 LKDs with the WHOQOL-BREF questionnaire. They found that LKDs experienced psychological distress post-donation, characterized by anxiety in 43.4% and depression in 29.5% of them. Similarly, another study,54 offered a comparative perspective, assessing the evolution of anxiety and depression symptoms in 48 LKDs through the SF-36 questionnaire. The 12-month prevalence of depressive and anxiety disorders following surgery was found to be 18%. Specifically, psychological disorders at the 12-month mark, assessed using the SF-36 questionnaire, were linked to the donor's psychosocial function (Mental Component Summary) (p<0.01), physical function (Physical Component Summary) at both 4 and 12 months (p<0.01), and the recipient's psychological condition at 12 months (p<0.05). De Groot et al.47 reported that 18% of 316 donors surveyed experienced reduced mental function post-donation, as measured by the Mental Component Summary (MCS) of the health-related quality of life (HRQoL) scale. In contrast, Guleria et al.52 who studied 100 LKD women, showed an overall improvement in post-donation psychological status assessed by the World Health Organization Quality of Life Questionnaire (WHO QoL Brief) and the Hospital Anxiety and Depression Scale (HADS) compared to the pre-donation condition (p=0.000). Specifically, all donors experienced an improvement in the psychological domain of the questionnaire (p<0.0001) and, in particular, mother donors demonstrated a significant decrease in depression score (p<0.0001). The study did not demonstrate a significant change in anxiety scores (p=0.065) after kidney donation. Due to the international nature of the included studies, results may not be directly applicable to the Italian healthcare context or to other specific national populations.

Seven studies47–53 provide a broad assessment of QoL among LKDs, by using different tools including the WHOQOL-BREF, the SF-36, and Kidney Disease Quality of Life Instrument (KDQOL-SF). Some studies evaluated QoL both before and after kidney donation,49,52,53 while others focused exclusively on the phase after the donation.47,48,50,51

Chien et al.53 conducted a study involving 14 LKDs, to investigate changes in their QoL through the SF-36 questionnaire before and three months after laparoscopic nephrectomy. They found a decline in physical function, role limitations and general health perceptions reduction after donation compared to baseline (SF-36 score 80.4±16.6 vs 92.9±5.0; p=0.004). A similar result was observed in the longitudinal prospective study by Garcia et al.,49 which evaluated the quality of life (QoL) of 50 living kidney donors (LKDs) before donation, as well as three months and one year after donation. The study found consistent QoL scores one-year post-donation (physical health=60.40±3.1) compared to pre-donation levels (physical health=59.67±4.4). After one year, 72% of donors reported an improvement in their health, while 22% stated their health remained unchanged. Additionally, three studies47,48,51 examined the QoL and physical health of kidney donors, comparing their results to those of the general population. De Groot et al.47 assessed the health-related quality of life (HRQoL) in 316 donors who donated between 1997 and 2009, finding that, on average, donors exhibited a higher HRQoL than the general population. However, 12% of donors reported lower physical HRQoL (Physical Component Summary, PCS), which was associated with a higher body mass index (BMI) and pre-donation smoking habits. These individuals also experienced increased fatigue and reduced social participation. Similarly, another study48 found that donor QoL scores were consistently higher than those of the general population, regardless of the time elapsed since donation. In this study, 91% of donors rated their health as good, very good, or excellent, with only 6% describing it as fair and 3% as poor. Additionally, 91% reported experiencing mild or no pain around the surgical scar, and 94% indicated they would donate again if given the opportunity. In contrast, the study by Shi et al.51 found that donors’ physical QoL was lower than that of the general population. It was observed that the recipient's poor health negatively impacted all domains of the donors’ QoL, including the physical dimension. A graphical summary of the results is shown in Fig. 2. The heterogeneity of the instruments used and the sociodemographic variability among donors limit the comparability of results and preclude definitive conclusions or generalizability to specific populations. Although work ability represents a key component of post-donation recovery and long-term donor well-being, no studies included in this scoping review have examined this outcome. The absence of data in this domain is particularly concerning, given that the ability to resume occupational activities constitutes a crucial element of psychosocial reintegration and may significantly affect donors’ physical health, mental well-being, and socioeconomic stability. This notable gap underscores the importance of future investigations aimed at systematically assessing the impact of living kidney donation on occupational functioning and vocational trajectories.

Fig. 2.

Synthesis of outcomes in living kidney donors: pain, quality of life, mental health, and gaps in work ability evidence. Summary of the results of the scoping review.

The main limitation of this review lies in the predominantly observational nature of the included studies, which restricts the ability to establish clear causal relationships between the variables analyzed. Additionally, the studies showed significant variation in methodological quality. These constraints may weaken the reliability of the review's conclusions, underscoring the need for future research, preferably using well-designed randomized controlled trials (RCTs), to confirm the findings. Moreover, differences in outcome measurement tools across studies and linguistic limitations in study selection may further restrict generalizability. The predominance of non-Italian contexts also raises questions about applicability to national populations.