Korean J Transplant.  2020 Jun;34(2):84-91. 10.4285/kjt.2020.34.2.84.

Long-term compensation of renal function after donor nephrectomy

• Lee YP
• Kim SJ
• Lee J
• Lee JG
• Huh KH
• Joo DJ
• Kim SI
• Kim YS
• Kim MS

• KMID: 2503884
• DOI: http://doi.org/10.4285/kjt.2020.34.2.84

Abstract

Background
Living donors are the major source of kidneys in countries with a shortage of deceased donors. Kidney donation after careful donor selection is generally accepted as a safe procedure, but the physiologic consequences after donor nephrectomy are not fully verified. In this study we retrospectively reviewed the renal function of the residual kidney in living donors.
Methods
Post-nephrectomy laboratory data of 1,175 living donors (60.7%) from 1,933 living donors who received uninephrectomy from January 1999 to December 2017 at Yonsei University, Severance Hospital, Korea were retrospectively collected. Post-nephrectomy renal function was monitored by the relative ratio of estimated glomerular filtration rate (e-GFR; pre-nephrectomy e-GFR ratio vs. post-nephrectomy e-GFR) that was calculated by the Modification of Diet in Renal Disease formula.
Results
During 36.3±37.6 months of mean follow-up, two cases (0.17%, 2/1,175) of renal failure developed. The mean e-GFR decreased to 64.3±14.2 mL/min/1.73 m2 immediately after nephrectomy from 99.2±19.9 mL/min/1.73 m2 of the pre-nephrectomy e-GFR. Early decrement of e-GFR was prominent in male and obese donors (body mass index >25 kg/m2, P<0.05). The e-GFR ratio increased according to post-nephrectomy duration, and the mean increment degree of e-GFR ratio after nephrectomy calculated by linear regression analysis was 1.94% per year. Unlike the early decrement of e-GFR ratio after nephrectomy, donor factors such as degree of obesity and donor sex did not affect the late increment of e-GFR ratio after nephrectomy (P>0.05).
Conclusions
Our data showed that long-term compensation of the renal function after nephrectomy occurs independently of preoperative donor characteristics.

Keyword

Glomerular filtration rate; Nephrectomy; Living donors; Kidney transplantation

Figure

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  Fig. 1 Change of estimated glomerular filtration rate (e-GFR) by Modification of Diet in Renal Disease (MDRD) formula at pre- and post-nephrectomy. Values are presented as mean±standard deviation.

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  Fig. 2 Late compensation of residual renal function after donor nephrectomy. y=66.216+0.162*×(R2=0.199, P<0.001). e-GFR, estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease.

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  Fig. 3 Late compensation of residual renal function after donor nephrectomy between two age groups (age <35, ≥35 years; P=0.136). e-GFR, estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease.

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  Fig. 4 Late compensation of residual renal function after donor nephrectomy between two body mass index (BMI) groups (P=0.466). e-GFR, estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease.

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  Fig. 5 Late compensation of residual renal function after donor nephrectomy in female donors and male donors (P=0.004). e-GFR, estimated glomerular filtration rate; MDRD, Modification of Diet in Renal Disease.

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