Impact of renal donation. Long-term clinical and biochemical follow-up of living donors in a single center

doi:10.1016/0002-9343(85)90010-5

The American Journal of Medicine

Volume 79, Issue 2, August 1985, Pages 201-208

https://doi.org/10.1016/0002-9343(85)90010-5 Get rights and content

Abstract

Forty-six renal donors who responded to a questionnaire and two additional donors with nephrotic syndrome and renal insufficiency were studied. The mean age was 46 ± 2.0 years (mean ±SE). Duration of follow-up was 6 ± 0.5 years. Serum creatinine levels increased from 1.0 ± 0.03 mg/dl before donation to 1.2 ± 0.04 mg/dl at follow-up. The incidence of proteinuria (more than 150 mg over 24 hours) was 39 percent. The serum creatinine level was 1.0 ± 0.08 mg/dl and 1.2 ± 0.06 mg/dl in the proteinuric and nonproteinuric groups, respectively. The incidence of hypertension was 31 percent with a serum creatinine level of 1.1 ± 0.11 mg/dl and 1.2 ± 0.07 mg/dl in the hypertensive and normotensive groups, respectively. One patient with nephrotic syndrome had proliferative glomerulonephritis. It is concluded that renal donation is associated with a minimal but statistically significant increment in serum creatinine levels. The incidence of mild hypertension and proteinuria is increased, but impact on renal function is minimal as assessed by serum creatinine determination.

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The Prevailing Preference for Left Nephrectomy in Living Donor Transplantation Does Not Adversely Affect Long-Term Donor and Recipient Outcomes
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Citation Excerpt :
In the current study, there was no significant difference between donors undergoing left or right nephrectomy. Most long-term follow-up studies after living kidney donation have shown a small but convincing increase in the incidence of hypertension compared with the general population [27-31]. However, most of these studies do not compare the study population with a matched group of general population and therefore may represent a risk for overestimation.
In living donor renal transplantation, surgeons traditionally prefer the left kidney for donation. The aim of this study was to assess the effects of the choice of laterality of donor nephrectomy on donor and recipient outcomes.
The data was obtained from the UK National Health Service Blood and Transplant (NHSBT). During the study period, 7919 donor nephrectomy and transplantation were carried out in 24 transplant centers. Of these procedures, 6407 (80.9%) were left and 1512 (19.1%) were right kidney donors.
Right kidney donation was associated with higher incidence of surgical site infection in the donor. Recipient outcome was superior for left-sided kidneys in terms of immediate graft function, delayed graft function, graft loss within 30 days, and graft survival at 3 years, but not at 1 and 5 years. Open donor nephrectomy (n = 2396, 30.2%) was associated with higher rates of pneumothorax and hemorrhage, longer hospital stay, and inferior graft survival at 3 and 5 years compared with laparoscopic donor nephrectomy (n = 5523, 69.8%).
A right donor nephrectomy is associated with higher rate of wound infection in the donor and similar long-term graft outcomes in the recipients. Laparoscopic donor nephrectomy offers lower rate of major complications in the donor and a better overall graft survival.
The National Landscape of Living Kidney Donor Follow-Up in the United States
2017, American Journal of Transplantation
In 2013, the Organ Procurement and Transplantation Network (OPTN)/ United Network for Organ Sharing (UNOS) mandated that transplant centers collect data on living kidney donors (LKDs) at 6 months, 1 year, and 2 years postdonation, with policy-defined thresholds for the proportion of complete living donor follow-up (LDF) data submitted in a timely manner (60 days before or after the expected visit date). While mandated, it was unclear how centers across the country would perform in meeting thresholds, given potential donor and center-level challenges of LDF. To better understand the impact of this policy, we studied Scientific Registry of Transplant Recipients data for 31,615 LKDs between January 2010 and June 2015, comparing proportions of complete and timely LDF form submissions before and after policy implementation. We also used multilevel logistic regression to assess donor- and center-level characteristics associated with complete and timely LDF submissions. Complete and timely 2-year LDF increased from 33% prepolicy (January 2010 through January 2013) to 54% postpolicy (February 2013 through June 2015) (p < 0.001). In an adjusted model, the odds of 2-year LDF increased by 22% per year prepolicy (p < 0.001) and 23% per year postpolicy (p < 0.001). Despite these annual increases in LDF, only 43% (87/202) of centers met the OPTN/UNOS-required 6-month, 1-year, and 2-year LDF thresholds for LKDs who donated in 2013. These findings motivate further evaluation of LDF barriers and the optimal approaches to capturing outcomes after living donation.
Structural and Functional Adaptation of the Remnant Kidney After Living Kidney Donation: Long-Term Follow-up
2017, Transplantation Proceedings
Several adjustments occur after nephrectomy (NT) in the donor's remnant kidney. We investigated kidney donors 10 years after NT and compared several parameters before and after transplantation.
A total of 42 kidney donors of the University of Luebeck's Transplant Center were scheduled for a 10-year follow-up and were offered several investigations: laboratory tests, urinalysis and kidney ultrasound examination including determination of kidney volume (KV), resistive index (RI) and pulsatility index (PI). Moreover, a 24-hour ambulatory blood pressure monitoring (ABPM) was performed. A review of the medical records allowed comparison of the investigated parameters before (t₀), 1 month after (t_0.1), and 10 (t₁₀) years after NT.
Creatinine clearance decreased from 94.3 ± 23 (t₀) to 52.4 ± 22 mL/min/1.73 m² (t_0.1) and increased to 78.2 ± 19 mL/min/1.73 m² after 10 years (t₁₀). Tubular proteinuria (α₁-microglobuline) increased from 6.1 ± 1.5 (t₀) to 63 ± 4.8 (t_0.1) (P < .05) and decreased to 36 ± 2.4 mg/g creatinine at t₁₀ (P < .05). Ultrasound examinations revealed a growth of the KV from 159.8 ± 23.1 (t₀) to 175.5 ± 22.1 mL (t₁₀) (P < .05) and an increase of RI and PI from t₀ of 0.63 ± 0.01 and 1.03 ± 0.03 to t₁₀ of 0.72 ± 0.04 (P < .05) and 1.24 ± 0.11 (P < .05), respectively. Post-NT ABPM values were not significantly different from pre-NT values.
NT leads to hypertrophy of the remnant kidney associated with an increase of organ volume and creatinine clearance after 10 years of follow-up. Our results indicate an excellent prognosis for the kidney donors without any signs of renal damage.
Role of Glomerular Mechanical Stress in the Pathogenesis of Chronic Kidney Disease
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Role of Glomerular Mechanical Stress in the Pathogenesis of Chronic Kidney Disease
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Association of the metabolic syndrome and long-term renal function in kidney donors
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Metabolic syndrome (MetS) may represent risk factor for long-term renal function of kidneys from living donors. The aim of this study was to evaluate the impact of MetS on renal function in donors.
Data regarding the presence or absence of MetS and renal function, as assessed by estimated glomerular filtration rate (eGFR) were obtained from 140 kidney donors before nephrectomy (BN) and at follow-up (AF). Donors were divided into those with (group 1; n =28) versus without MetS (group 2; n = 112).
Comparing the groups, we observed a significantly greater reduction in eGFR among the group with MetS BN versus AF 27.5% (19.3–33.0) versus 21.4% (9.6–34.1 P = .02) respectively using a Cox regression model, including age, gender, serum uric acid, body mass index (BMI), and basal eGFR, MetS BN (hazard ratio = 2.2; 95% confidence interval [CI], 1.21–4.01; p = .01) was an independent factor associated with a greater risk of a-eGFR <70 mL/min/1.73 m² at follow-up (P < .001). Additionally, age (hazard ratio = 1.03%; 95% CI, 1.01–1.06; P < .001), and female gender (hazard ratio = 1.86; 95% CI, 1.03–3.36; P = .03) were associated with a greater decrease in eGFR. Individuals with MetS BN showed a GFR <70 mL/min/1.73 m² at significantly shorter follow-up time (5.6 ± 0.8 years) versus persons without MetS (12.8 ± 1.0 years; P = .001)
Kidney donors with MetS BN experiment a significantly greater decrease in eGFR at follow-up.

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Impact of renal donation. Long-term clinical and biochemical follow-up of living donors in a single center

Abstract

J Urol

Kidney Int

Kidney Int

Kidney Int

Am J Kidney Dis

Kidney Int

J Urol

Survival with dialysis and transplantation in patients with end-stage renal disease

N Engl J Med

The use of living donors

Functional and hemodynamic adaptation to progressive renal ablation

Circ Res

Dynamics of glomerular ultrafiltration in the rat. VII. Response to reduced renal mass

Am J Physiol

Renal function in 29 healthy adults before and after nephrectomy

JAMA

Renal function in donors and recipients of renal allotransplantation

Ann Intern Med

Response to unilateral nephrectomy in old rats

Arch Pathol

X-ray induced glomerulosclerosis in rats: modification of lesion by food restriction, uninephrectomy and age

J Gerontol

Ultrastructural studies of X-ray induced glomerular disease in rats subjected to uninephrectomy and food restriction

Lab Invest

Accelerated induction of kidney neoplasms in mice after x-radiation (690 rad) and unilateral nephrectomy

JNCI

Hyperfiltration in remnant nephrons: a potentially adverse response to renal ablation

Am J Physiol