Evaluation of Renal Function in Living Kidney Donors by Isotopic Measurement of Glomerular Filtration Rate with 99mTc-DTPA

Abstract

Introduction. Accurate assessment of kidney function in living kidney donors is essential prior to surgery. The aim of this study is to demonstrate the value of 99mTc DTPA isotope Glomerular Filtration Rate measurements (GFRmDTPA) in kidney donors compared to the estimated technique (GFReMDRD). Methods. 203 kidney donor’s candidates (119 women and 84 men) had a GFRmDTPA after intravenous injection of 37 MBq 99mTc-DTPA, followed by two blood samples at 2h and 4h post-injection. DFGmDTPA was compared to GFReMDRD and patients were classified according to KDIGO 2012 stages. Patients selected for transplantation were those with a GFR ≥ 80ml/min/1.73m2. Results. Mean GFRmDTPA was 93 ml/min/1.73m2 versus 95 ml/min/1.73m2 for GFReMDRD. 124 patients (61.1%) were at stage 1 with GFRmDTPA vs 113 by GFReMDRD (55.7%). 73 patients (36%) at stage 2 by GFRmDTPA vs 87 by GFReMDRD (42.9%). 6 patients (3%) were at stage 3 by GFRmDTPA and 3 by GFReMDRD (1.5%). A total of 151 patients achieved a GFRmDTPA ≥ 80ml/min/1.73m2 and selected into the transplant protocol, compared to 146 by GFReMDRD. 52 patients with GFRmDTPA less than 80ml/min/1.73m2 compared to 57 by estimated technique were rejected from the transplant protocol based on GFRmDTPA results. Conclusion. GFRmDTPA is a referent method in the evaluation and selection of potential kidney donors’ candidates with an impact on the transplant decision, but requires indications adapted to this population.