Caring for our donors. Identification, analysis and prevention of chronic pain after living kidney donation

kidney transplantation Kidney Donation Chronische pijn

G. Nieuwenhuijs
R. R.A. Pol
prof. dr. A.P. Wolff
L. Westenberg

Nature of the research:
retrospective study in all patients identified with pain after donation in our first analysis and the TransplantLines database

Fields of study:
anesthesiology surgery nephrology

Background / introduction
Studies on pain after living kidney donation, living liver donation, laparoscopic hysterectomy and ovariectomy show a wide range in prevalence of chronic pain with numbers reported of 5.7-25%, 27-42% and 4.7-32% respectively. Our previous study in living kidney donors within the UMCG showed a surprisingly high prevalence of 25%, which to our opinion is unacceptable since these formerly healthy individuals donated a kidney without direct benefit for themselves.1 In addition this has a societal and financial impact since the presence of chronic pain can lead to inability to work or function in society.
Most studies attribute the development of chronic pain to the process of central sensitization. Due to persistent stimulation of pain receptors pre or perioperative, changes in nociceptive pathways are induced (neuroplasticity). These changes cause hyper excitability of the central nerve system in which nociceptive signals are enhanced and preserved (hyperalgesia).2 In addition there can be signs of allodynia in which pain is caused by a stimulus that does not normally elicit pain. Sensitization has shown to be responsible for an increase in acute postoperative pain due to hyperalgesia of the surgical wound area and is an important factor in the development of chronic pain.3 Next to this direct injury of nerves during the surgery has been shown to lead to neuroplasticity in the peripheral as well as the central nervous system again after which central sensitization can take place.4 Known risk factors for transition of acute to chronic pain are: genetic predisposition, psychosocial factors, preoperative pain, surgical factors, severe acute postoperative pain.5-8
Research question / problem definition
In our first project we assessed the prevalence of chronic pain in our living kidney donors.1 To design a therapeutic strategy to reduce the incidence of chronic pain in these relatively healthy individuals, we first have to define what kind of chronic pain these patients suffer from. Therefore we will proceed with a retrospective study in all patients identified with pain after donation in our first analysis and the TransplantLines database. Patients will receive various pain questionnaires by mail. Data after completion will be imported in a database and analysed.
This project has the potential to be expanded to a MD-PhD trajectory in which a more molecular part (inflammation and development of pain) and a randomized intervention study can be implemented
Patients will receive various pain questionnaires by mail. Data after completion will be imported in a database and analysed
What we can offer
- participation in a multidisciplinary (anesthesiology, surgery, nephrology) research group within the framework of the Dutch Kidney Transplant Research Group.
- data collection, data entry and coordination of follow-up visits for patients
- possibility to develop related research questions in your own field of interest
- developing of writing skills and possibility to publish in international scientific journals
- development of presentation skills by presenting data on international meetings
- support of the research agency of the department of Anesthesiology/Surgery

What we are looking for
An independent student with:
- coordination and cooperation skills
- an analytical mind
- writing skills are a pre.
- mastering the Dutch and English language
1. Zorgdrager M, van Londen M, Westenberg L, Nieuwenhuijs‐Moeke G, Lange J, de Borst M et al. Chronic pain after hand‐assisted laparoscopic donor nephrectomy. BJS. 2019;106(6):711-719.
2. Voscopoulos C, Lema M. When does acute pain become chronic? Br J Anaesth. 2010;105:i85.
3. Richebé P, Capdevila X, Rivat C. Persistent Postsurgical Pain: Pathophysiology and Preventative Pharmacologic Considerations. Anesthesiology. 2018;129(3):590-607.
4. Brandsborg B, Dueholm M, Kehlet H, Jensen T, Nikolajsen L. Mechanosensitivity before and after hysterectomy: a prospective study on the prediction of acute and chronic postoperative pain. British Journal of Anaesthesia. 2011;107(6):940-947.
5. Katz J, Seltzer Ze. Transition from acute to chronic postsurgical pain: Risk factors and protective factors. Expert Rev Neurother. 2009;9:723-744.
6. Macrae W. Chronic post-surgical pain: 10 years on. British Journal of Anaesthesia. 2008;101(1):77-86.
7. Fregoso G, Wang A, Tseng K, Wang J. Transition from Acute to Chronic Pain: Evaluating Risk for Chronic Postsurgical Pain. Pain Physician. 2019;22:479-488.
8. Callesen T, Bech K, Kehlet H. Prospective study of chronic pain after groin hernia repair. BJS. 1999;86:1528-1531.
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