Donor Renal Function Research Articles

Comparison of Single-Port Robotic Donor Nephrectomy and Laparoscopic Donor Nephrectomy.

Purpose: To compare the intra- and postoperative outcomes of single-port robotic donor nephrectomies (SP RDNs) and laparoscopic donor nephrectomies (LDNs). Materials and Methods: We retrospectively reviewed our institutional database for patients who received LDN or SP RDN between September 2020 and December 2022. Donor baseline characteristics, intraoperative outcomes, postoperative outcomes, and recipient renal function were extracted and compared between LDN and SP RDN. SP RDN learning curve analysis based on operative time and graft extraction time was performed using cumulative sum analysis. Results: One hundred forty-four patients underwent LDN and 32 patients underwent SP RDN. LDN and SP RDN had similar operative times (LDN: 190.3 ± 28.0 minutes, SP RDN: 194.5 ± 35.1 minutes, p = 0.3253). SP RDN patients had significantly greater extraction times (LDN: 83.2 ± 40.3 seconds, SP RDN: 204.1 ± 52.2 seconds, p < 0.0001) and warm ischemia times (LDN: 145.1 ± 61.7 seconds, SP RDN: 275.4 ± 65.6 seconds, p < 0.0001). There were no differences in patient subjective pain scores, inpatient opioid usage, or Clavien-Dindo II+ complications. Short- and medium-term postoperative donor and recipient renal function were also similar between the groups. SP RDN graft extraction time and total operative time learning curves were achieved at case 27 and 13, respectively. Conclusion: SP RDN is a safe and feasible alternative to LDN that minimizes postoperative abdominal incisional scars and has a short learning curve. Future randomized prospective clinical trials are needed to confirm the findings of this study and to identify other potential benefits and drawbacks of SP RDNs.

Arteriolar hyalinization at 0-hour biopsy predicts long-term graft function in deceased kidney transplantation.

Regarding the relationship between donor kidney quality and renal graft function after deceased kidney transplantation (KTx) following donation after cardiac death (DCD), the evaluation timing varies depending on the study. Evaluation of histology and changes in long-term renal graft function is limited. A retrospective single-center study included 71 recipients who underwent 0-hour biopsy for KTx from DCD. The recipients were divided into two groups to evaluate factors related to renal graft function (study1). The two groups were categorized as stable graft function and poor graft function with the change of estimated glomerular filtration rate (eGFR) after KTx. The recipients were then divided into four groups to assess whether the factors identified in study1 were related to the change in long-term renal graft function (study2). They were categorized as follows: Improved, Stable, Deteriorated, and Primary non-function with the change of eGFR after KTx. In study1, donor age ≥ 50 years (29.5% vs. 65.2%; p = 0.09), banff arteriolar hyalinosis (ah) score (0.66 ± 0.78 vs. 1.2 ± 1.0; p = 0.018), and presence of glomerulosclerosis (43.2% vs. 76.2%; p = 0.017) were significant risk factors for poor long-term graft function. When the recipients were divided into four groups, the severity of ah correlated well with changes in long-term renal function. We can predict the shift in long-term renal graft function after KTx from DCD according to the severity of ah by 0-hour biopsy.

Computed Tomography Renal Volumetry Better Predicts Postoperative Donor Renal Function in Live Kidney Donor Transplantation than Renal Scintigraphy: A Comparative Study

Introduction and Objectives: Both computed tomography (CT) and renal scintigraphy (RS) have been used to assess vascular anatomy, renal status, and split renal function (SRF). In this study, we used a recently developed software that facilitates renal volumetric evaluations to compare RS and automated CT volumetry for assessing residual renal function and, thus, estimating postoperative renal function after donor nephrectomy. Methods: Fifty-one cases of donor nephrectomy were analyzed. Residual renal function was estimated based on RS and CT volumetry. The correlation between the postoperative estimated glomerular filtration rate (eGFR) and expected SRF, measured using RS and three types of CT volumetry data (ellipsoid, thin-slice, and 5-mm slice data), was determined. Results: The correlation coefficient between actual eGFR and expected SRF was significantly associated at each time point and modality (p < 0.0001). At any time point, the difference in correlation coefficient between RS and 5-mm volumetry was significant (p value: 0.003–0.018), whereas the differences in correlation coefficients between RS and the triaxial volume calculation, and the triaxial volume calculation and 5-mm volumetry, were generally statistically insignificant. Conclusions: Expected SRF was estimated more accurately by CT volumetric calculations (especially 5-mm slice-based volumetry) than RS.

Creatinine clearance in selection of living kidney donor among the Malaysian population: is it safe?

BackgroundAssessment of donor renal function is made by the measurement of Glomerular Filtration Rate (GFR). Exogenous markers are preferred over creatinine clearance and are widely used for measuring GFR. However, they are difficult to obtain, costly and laborious. This is a study to look into the safety and accuracy of creatinine clearance for renal assessment among the living kidney donors in the Malaysian population.MethodsThis is a retrospective, single-centre study comprising 105 living kidney donor candidates from the year 2007 to 2020. By comparing against 51-Chromium ethylenediamine-tetraacetic acid (51Cr-EDTA), we analysed creatinine clearance for correlation, bias, precision and accuracy.ResultsThe study group had a mean age of 45.68 ± 10.97 years with a mean serum creatinine of 64.43 ± 17.68 µmol/L and a urine volume of 2.06 ± 0.83 L. Mean measured GFR from 51Cr-EDTA was 124.37 ± 26.83 ml/min/1.73m2 whereas mean creatinine clearance was 132.35 ± 38.18 ml/min/1.73m2. Creatinine clearance overestimated 51Cr-EDTA significantly with a correlation coefficient of 0.48 (p < 0.001) and an accuracy of 78.10% and 64.0% within 30% and 20% respectively of 51Cr-EDTA.ConclusionCreatinine clearance is an acceptable and affordable alternative for donor renal assessment in the absence of exogenous markers with an emphasis on adequate urine collection followed by using measured GFR in selected cases.

CT volumetry performs better than nuclear renography in predicting estimated renal function one year after living donation

The evaluation of split renal function (SRF) is a critical issue in living kidney donations and can be evaluated using nuclear renography (NR) or computerized tomography (CT), with unclear comparative advantages. We conducted this retrospective study in 193 donors to examine the correlation of SRF assessed by NR and CT volumetry and compared their ability to predict remaining donor renal function at 1 year, through multiple approaches. A weak correlation between imaging techniques for evaluating the percentage of the remaining kidney volume was found in the global cohort, with an R2 = 0.15. However, the Bland–Altman plot showed an acceptable agreement (95% of the difference between techniques falling within − 8.51 to 6.11%). The predicted and observed eGFR one year after donation were calculated using the CKD-EPI, and CG/BSA equations. CT volume showed a better correlation than NR for both formulas (adjusted R2 of 0.42. and 0.61 vs 0.37 and 0.61 for CKD-EPI and CG/ BSA equations, respectively). In non-nested modeling tests, CT volumetry was significantly superior to NR for both equations. CT volumetry performed better than NR in predicting the estimated renal function of living donors at 1-year, independently from the eGFR equation.

236.11: A Comparison of the Effects of Intravenous vs Oral Hydration on Subclinical Acute Kidney Injury in Laparoscopic Donor Nephrectomy: A Randomised Controlled Trial

Importance: Laparoscopic and laparoscopic assisted donor nephrectomy is the most common method of donor nephrectomy. Despite improving the outcome for donors by reducing post-operative pain and speeding up recovery, the technique exposes the kidney to additional haemodynamic stresses in terms of extreme position and pneumoperitoneum. Any intervention that could protect the kidney may further improve the residual function of both donated and remaining kidney. Objective: To determine if preoperative intravenous fluids given overnight, prior to morning kidney donation will result in a measurable improvement in intraoperative haemodynamics and a decrease in subclinical acute kidney injury. Trial Design: A single centre, prospective single-blinded randomised controlled trial. Participants: All adult patients aged >18 years of age undergoing live donor laparoscopic hand-assisted nephrectomy eligible to participate. Interventions: Intervention group: The evening prior to surgery, between midnight and 8am, patients in this group will receive three litres of crystalloid solution, IV, in addition to unrestricted oral fluid. Control group: Patients in this group will also be admitted on the evening prior to surgery but will not be given intravenous fluids. They will only receive unrestricted oral fluids. Main Outcomes: The primary outcome will be a rise in, serum biomarker for acute kidney injury, neutrophil-gelatinase associated lipocalin (N-GAL). Secondary outcomes include donor and recipient renal function, DGF, intraoperative haemodynamics, perioperative complications. Results: A total of 76 patients (median [IQR] age, 50 [42-57], 44[57%] male) were randomised (36 to preoperative intravenous fluids and 40 to no intravenous fluids) and followed up for 1 year. Serum N-GAL was significantly lower immediately post laparoscopic donation in the intervention group (median [95% CI] intravenous fluids, 95ng/ml [68-133] vs control, 131ng/ml [103-156]; P<.036) but not significantly different at day one post operatively. There was no significant difference between groups in renal function of donors at 6 weeks and 1 year post donation. Intraoperative urine output was significantly higher in the intervention group, but all haemodynamic parameters demonstrated a similar trend between both groups with no significant differences. Conclusions: Intravenous hydration prior to laparoscopic donor nephrectomy statistically reduces serum N-GAL post operatively but is unlikely to be clinically significant. Therefore, patients undergoing laparoscopic kidney donation would not seem to benefit from admission the day prior to surgery, for intravenous fluid hydration, and could be admitted the day of surgery in keeping with the principles of enhanced recovery protocols.

Cardiac donors with renal impairment: Usage and outcomes after heart transplant.

Utilization of hearts from donors with significant renal dysfunction and the impact of donor renal function on outcomes following heart transplant (HT) is unknown. We sought to investigate the trends, characteristics and outcomes associated with these donor hearts and the impact of donor renal function on survival and graft failure in adult HT recipients. We reviewed theScientific Registry of Transplant Recipients (SRTR) and summarized trends, characteristics and outcomes of hearts from adult donors by renal impairment. Single-organ HTs were evaluated and stratified by donors with estimated glomerular filtration rate (eGFRs) < and ≥30ml/min. We constructed Cox proportional hazards regression models to compare time-to-mortality over 30-day, 1-, 3-, and 5-year time-horizons between groups, and the association of donor eGFR group with graft failure. A total of 162,586 adults were evaluated for cardiac donation, of which, 22,780 (14%) had an eGFR≤30ml/min. Donors with an eGFR≤30ml/min increased over time, from 7.2% (358/4966) in 2000 to a high of 19.5% (2283/11,728) in 2020. Such donors were significantly more likely discarded (not offered (7.9%vs. 9.8%, p<.001) or accepted (62.6%vs. 72.2%, p<.001), and less likely to be transplanted (18.0 % vs. 29.5%; p<.001). Of 41,044 HT recipients, 3906 (9.5%) had hearts from such donors.Primary graft failure was similar between groups (OR 1.20, 95% CI .91-1.58; p=.1) while adjusted mortality was lower for recipients from donors with eGFR≤30ml/min. More than two-third of hearts from donors with renal dysfunction are discarded. Recipients from donors with renal dysfunction sustained lower mortality post HT during the study period. Increased evaluation and utilization of donors with renal dysfunction has the potential to expand the critically low donor pool.

Rethinking the Impact of Donor eGFR on Heart Transplant Outcomes

<h3>Purpose</h3> With limited evidence regarding the effect of donor renal function on outcomes post-cardiac transplant, this study sought to determine if donor eGFR has an impact on post-transplant outcomes in patients undergoing heart transplantation. <h3>Methods</h3> The UNOS Registry was queried for all cardiac transplant recipients and stratified into two groups by donor eGFR: eGFR >60 (high) or eGFR <60 (low). Baseline characteristics were compared via standard statistical analysis. Survival analysis was censored at 5-years using Kaplan-Meier analysis, and Cox proportional regression analysis was adjusted for age, sex, diabetes, race, ischemic time, dialysis, life support, waiting time, and HLA mismatch. <h3>Results</h3> 37205 subjects were grouped to high eGFR and 14892 subjects to low eGFR. Donors with low eGFR were more likely to be older (31.3 vs 32.9, p< 0.001). Recipients were more likely to be older (54.7 years vs 52.4, p<0.001) and male (77.2% vs 74.3% p<0.001). Compared to the high eGFR group, heart transplant recipients from donors in the low eGFR group showed no significant difference in mortality (p= 0.30) or causes of death (p= 0.054). Unadjusted analysis showed a hazard ratio of 0.978 (0.938-1.019 95% CI). Following adjustment, HR was 0.992 (0.948-1.039 95% CI). <h3>Conclusion</h3> Our study presents preliminary data to demonstrate cardiac donors with low eGFR have similar outcomes and life expectancy up to 60 months as compared to donors with high eGFR. With further research, there is an opportunity to expand the eligibility requirements for donor heart procurement and thereby increase the potential donor pool.

Robotic versus hand-assisted laparoscopic living donor nephrectomy: comparison of two minimally invasive techniques in kidney transplantation

Robot-assisted donor nephrectomy (RDN) is increasingly used due to its advantages such as its precision and reduced learning curve when compared to laparoscopic techniques. Concerns remain among surgeons regarding possible longer warm ischemia time. This study aimed to compare patients undergoing robotic living donor nephrectomy to the more frequently used hand-assisted laparoscopic nephrectomy (HLDN) technique, focusing on warm ischemia time, total operative time, learning curve, hospital length of stay, donor renal function and post-operative complications. Retrospective study comparing RDN to HLDN in a collaborative transplant network. 176 patients were included, 72 in RDN and 104 in HLDN. Left-sided nephrectomy was favored in RDN (82% vs 52%, p < 0.01). Operative time was longer in RDN (287 vs 160 min; p < 0.01), while warm ischemia time was similar (221 vs 213 secs, p = 0.446). The hospital stay was shorter in RDN (3.9 vs 5.7 days, p < 0.01).Concerning renal function, a slightpersistent increase of 7% of the creatinine ratio was observed in the RDN compared to the HLDN group (1.56 vs 1.44 at 1-month checkup, p < 0.01). The results show that RDN appears safe and efficient in comparison to the gold-standard HLDN technique. Warm ischemia time was similar for both techniques, whereas RDN operative time was longer. Patients undergoing RDN had a shorter hospital stay, this being possibly mitigated by differences in center release criteria. Donor renal function needs to be assessed on a longer-term basis for both techniques.

The Utility of Combined Urine Urea and Creatinine Clearance for Pretransplant Renal Function Assessment

Evaluation of donor renal function as glomerular filtration rate (GFR) is a crucial part of pretransplant workup. Most guidelines recommend measured GFR (mGFR) using exogenous markers with creatinine clearance (CrCl) as an alternative. However, exogenous markers are difficult to obtain and perform, and CrCl may overestimate GFR. We explore the use of CrCl and combined urea and creatinine clearance as an alternative for GFR assessment. A retrospective study involving 81 kidney donors from 2007 to 2020, with mGFR collected by chromium 51-labeled ethylenediaminetetraacetic acid (51Cr-EDTA) and CrCl and combined urea and creatinine clearance. We analyzed the performance of CrCl and combined urea and creatinine clearance against 51Cr-EDTA. Adequacy of urine volume was taken into consideration. A total of 81 candidates with a mean age of 44.80 ± 10.77 years were enrolled. Mean mGFR from 51Cr-EDTA was 123.66 ± 26.91 mL/min/1.73 m2, and combined urea and creatinine clearance and CrCl were 122.13 ± 47.07 and 133.40 ± 36.32 mL/min/1.73 m2, respectively. CrCl overestimated 51Cr-EDTA. Though combined urea and creatinine clearance had minimal bias, it had a lower correlation coefficient (0.25 vs 0.43), lower precision (49.51 vs 38.10), and slightly lower accuracy within 30% of 51Cr-EDTA (74.07% vs 76.54%). Combined urea and creatinine clearance did not improve the performance of CrCl. Nevertheless, it can potentially be used as first-line GFR assessment, followed by mGFR in selected donors, to ascertain threshold of safe kidney donation. A stringent urine collection method is essential to ensure accurate measurement.

External Validation of a Predictive Model to Estimate Renal Function After Living Donor Nephrectomy.

Transplantation from living donor nephrectomy (LDN) is the best treatment for end-stage renal disease but observed decrease in donor renal function is a major concern. The aim of this study was to externally validate a predictive model to estimate 1-y postdonation estimated glomerular filtration rate (eGFR) and risk of chronic kidney disease (CKD) in living donors. All LDN performed at Necker Hospital from January 2006 to May 2018 were retrospectively included. Observed eGFR (using CKD-EPI formula) at 1-y post LDN was compared with the predicted eGFR calculated with a formula developed at Toulouse-Rangueil and based on predonation eGFR and age. Pearson correlation, receiver operating characteristics curve (ROC curve), and calibration curve were used to assess external validity of the proposed prognostic model to predict postoperative eGFR and occurrence of CKD in donors. Four hundred donors were evaluated with a mean postoperative eGFR of 62.1 ± 14 mL/min/1.73m2. Significant correlation (Pearson r = 0.66; P < 0.001) and concordance (Bradley-Blackwood F = 49.189; P < 0.001) were observed between predicted and observed 1-y eGFR. Area under the receiver operating characteristic curve of the model relevant accuracy was 0.86 (95% CI, 0.82-0.89). This study externally validated the formula to predict 1-y postdonation eGFR. The calculator could be an accurate tool to improve the selection of living kidney donor candidate.

Short- and Mid-Term Impact of Tobacco Smoking on Donor Renal Function Following Living Kidney Donation at a Tertiary Referral Hospital.

The negative impact of tobacco smoking on renal function has been widely studied. However, there is limited knowledge about the effect of smoking on pre-operative and post-operative renal function in living kidney donors. The objective of the study was to evaluate the short- and mid-term impact of smoking on donor renal function. This is a retrospective study of 308 patients who underwent living donor nephrectomy (LDN) at a tertiary referral hospital. We compared baseline characteristics as well as functional outcomes following LDN according to history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the modification of diet in renal disease equation in 6 time periods: pre-operative, 1 week, 1 month, 6 months, 12 months, and 24 months after surgery. We performed a Kaplan-Meier analysis for chronic kidney disease (CKD) outcome and binary logistic regression analysis to identify risk factors associated with CKD at 24 months of follow-up. Among donors, 106 (34.4%) reported a smoking history before nephrectomy. Smoking donors had worse pre-operative eGFR than non-smokers (90 ± 26.3 mL/min/1.73m2 vs. 96 ± 27 mL/min/1.73 m2, respectively; p = 0.02) and lower eGFR at 1 week (p = 0.01), 1 month (p ≤ 0.01), 6 months (p = 0.01), and 12 months (p = 0.01) after LDN. Tobacco smoking (OR 3.35, p ≤ 0.01) and age ≥ 40 years at donation (OR 6.59, p ≤ 0.01) were associated with post-operative development of CKD at 24 months after LDN. Living kidney donors with a tobacco smoking history had an increased risk of developing chronic kidney disease following nephrectomy. Smoking-cessation strategies should be implemented.

Shift in Living Kidney Donor Demographics Over the Past 50 Years in a German Transplant Center

BackgroundLiving kidney donors may face health risks after donation. Age, sex, body mass index, comorbidities, and relationship to the recipient have an impact on lifetime living kidney donor risk. In view of a changing landscape in renal transplantation with increasing organ shortages, the selection criteria for potential donors may have changed over time.Material/MethodsWe investigated donor demographics and outcomes in a cohort of 760 living kidney donors who donated from 1967 to 2016 at the transplant center in Heidelberg, Germany.ResultsThe living kidney donor age increased from 34.9±11.5 to 53.2±10.2 years, with 11.4% donors aged 65 years in the period from 2011 to 2016. The number of donors with comorbidities at the time of donation increased. The percentage of donors with a history of obesity, hypertension, smoking, and a family history of kidney disease enlarged to 18.6%, 36.1%, 37.0%, and 9.1%, respectively. De novo hypertension was a common problem in more than half of the donors at long-term follow-up, and donor renal function decreased about 30 mL/mi/1.73 m2.ConclusionsThis detailed analysis of living kidney donor demographics over the last 50 years detected an increased proportion of donors with higher age and comorbidities today. Careful donor selection, regular follow-up visits, and systematic donor registries are required to further improve donor outcomes.

Clinical assessment of stabilisation of renal function after nephrectomy.

Nephrectomy leads to derangement of renal function and various adaptive changes by the remaining kidney over a period of time. This study is performed to evaluate the amount of derangement of renal function in donor and radical nephrectomy, how much the remaining kidney adapts over a period of time and the time taken for stabilisation of renal function. A total of 60 patients who underwent nephrectomy (Radical/Donor) were followed up for 12 months with serial estimation of renal function and was compared with preoperative renal function. Data was analysed with statistical analysis. Patients who underwent radical nephrectomy had 37% initial decline in renal function which was later stabilised at 19% lower than baseline value. Patient who underwent donor nephrectomy had initially 39% decline in renal function which was later stabilised at 24% lower than normal. Removal of functional renal tissue led to reduction of renal function. This decline is more evident in the initial post-operative period and then begin to stabilise over months. The greater is the amount of normal tissue removed, the greater is the reduction of renal function and more time it will take to stabilise, increasing overall morbidity of the patient. This study suggests that even patients with normal GFRs should be followed up postoperatively to determine their ultimate renal functional outcomes.

Effect of donor kidney morphology parameters on the prognosis in living kidney transplantation recipients.

BackgroundThe effect of donor kidney morphology parameters on the prognosis of renal transplant recipients remains unclear.MethodsWe conducted a retrospective cohort study consisting of 290 pairs of donors and recipients who underwent living related renal transplantation in our center between December 2013 and December 2015. The donor kidney morphology parameters, demographic characteristics and renal function of the included participants were collected and analyzed.ResultsThe univariate linear regression analysis revealed that the donor kidney weight (DKW)/recipient body weight (RBW), DKW/recipient body surface area (RBSA), DKW/recipient body mass index (RBMI), donor kidney volume (DKV)/RBW, DKV/RBSA, DKV/RBMI, and donor body weight (DBW)/RBW were significantly correlated with estimated glomerular filtration rate (eGFR) and serum creatinine in recipients within two years of transplantation. In our multivariate linear regression analysis, DKW/RBW and donor age significantly correlated with eGFR at 6, 12, 18 and 24 months after transplantation. DKW/RBW had the best prediction performance for good renal allograft function at 12 months after transplantation. We found that when the age of the donor was 55 years and above, the prediction performance of the nephron dosing to the recipient’s metabolic demands mismatch was elevated. After grouping according to the donor’s age and DKW/RBW, the allograft function from different donor ages improved as DKW/RBW increased. The number of recipients who were rejected in the high DKW/RBW group was significantly fewer than those in the low and medium groups the 1, 2, and 3-year graft and patient survival rates were comparable among these groups. Furthermore, we also identified that when the age of the donor was 55 years and above, the threshold of DKW/RBW was 3.09 g/kg via the receiver operating characteristic curve, which predicted a good renal function 12 months after transplantation.ConclusionsThe donor kidney morphology parameters were significantly associated with early renal allograft function, especially when the age of the donor was 55 years and above.

Evaluation of Renal Function in Donar Following Kidney Donation

Objectives: To find out any changes in renal function in donor following kidney donation. Materials and Methods: A Hospital based prospective study was conducted in the Department of Urology of Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh from April 2011 to September 2012, Investigations included specific gravity and urinary microalbumin, ultrasonogram of kidneys, serum creatinine, estimated glomerular filtration rate. According to inclusion and exclusion criteria a total of 37 donors were enrolled in this study. Subsequent follow up were taken at the end of three months, six months and nine months. Data were evaluated by Paired t-test, Significance was defined p value&lt;0.05. Results: The age range varied from 25 to 39 years and almost a half (45.9%) of patients had age belonged to 25-30 years and male to female ratio was 1:2.4. The mean baseline specific gravity was 1016.97±8.03, serum creatinine 1.03±0.24. The baseline urinary microalbumin was found nil and subsequent 1st,2nd, and 3rd follow up were also nil. The mean difference of specific gravity, serum creatinine (mg/dl) and GFR estimated by cretainine clearance rate and DPTA were almost consistent between baseline and the subsequent follow-up, no statistical significant (P&gt;0.05) was found between baseline and the subsequent follow-up. Conclusion: Renal function of the remaining kidney in living donors does not significantly change after donor nephrectomy. Bangladesh Journal of Urology, Vol. 19, No. 1, Jan 2016 p.18-22

Long-term renal function in living kidney donors with simple renal cysts: A retrospective cohort study.

Simple (Bosniak I) renal cysts are considered acceptable in living kidney donor selection in terms of cancer risk. However, they tend to increase in number and size over time and might compromise renal function in donors. To clarify their implications for long-term renal function, we characterized the prevalence of renal cysts in 454 individuals who donated at our center from 2000 to 2007. We estimated the association between the presence of cysts in the kidney remaining after nephrectomy (ie, retained cysts) and postdonation eGFR trajectory using mixed-effects linear regression. Donors with retained cysts (N=86) were older (P<.001) and had slightly lower predonation eGFR (median 94 vs 98mL/min/1.73m2 , P<.01) than those without cysts. Over a median 7.8years, donors with retained cysts had lower baseline eGFR (-8.7 -5.6 -2.3 mL/min/1.73m2 , P<.01) but similar yearly change in eGFR (-0.4 0.02 0.4 mL/min/1.73m2 , P=.2) compared to those without retained cysts. Adjusting for predonation characteristics, there was no difference in baseline eGFR (P=.6) or yearly change in eGFR (P>.9). There continued to be no evidence of an association when we considered retained cyst(s) ≥10mm or multiple retained cysts (all P>.05). These findings reaffirm current practices of accepting candidates with simple renal cysts for donor nephrectomy.

Living Kidney Transplantation From Marginal Donors Presents Feasible Donor Renal Function Despite Inferior Recipient Renal Function

IntroductionKidney transplantation from marginal donors is an important solution for organ shortage problems. In this study, we evaluated the safety and effectiveness of living kidney transplantation from marginal donors at our hospitals. MethodsBetween June 2006 and April 2019, 107 patients underwent living kidney transplantation at our hospitals. Marginal donors were defined as those with 1. age >70 years, 2. hypertension, 3. creatinine clearance <80 mL/min, 4. body mass index >30 kg/m2, or 5. hemoglobin A1c >6.2%. We retrospectively compared renal function and its chronological changes between marginal and standard donors. We also compared graft survival and recipient renal function between the groups. ResultsThirty-one (29%) donors were defined as marginal. The primary reason for being defined as marginal was hypertension (74%). The mean age of the marginal donors (62 ± 10 years) was higher than that of standard donors (52 ± 12 years, P < .001). The estimated glomerular filtration rate (eGFR) before and after transplantation was lower in the marginal group, whereas the decline ratio of eGFR was not different between the marginal and standard donors. Five-year graft survival of transplantations from marginal donors (89%) was not significantly inferior to that from standard donors (95%). Meanwhile, recipient eGFR was lower in transplantation from marginal donors than standard donors from 1 month through 5 years after transplantation. ConclusionsNo significant differences were observed between the groups regarding the decline ratios of donor eGFR and graft survival. Thus, transplantation from marginal donors may be a feasible solution for donor shortage problems.

MP52-07 SHORT AND LONG TERM IMPACT OF TOBACCO SMOKING ON DONOR RENAL FUNCTION FOLLOWING LIVE KIDNEY DONATION

You have accessJournal of UrologyTransplantation & Vascular Surgery: Renal Transplantation & Vascular Surgery II (MP52)1 Apr 2020MP52-07 SHORT AND LONG TERM IMPACT OF TOBACCO SMOKING ON DONOR RENAL FUNCTION FOLLOWING LIVE KIDNEY DONATION Christopher Kauffman-Ortega*, Adrian M. Garza-Gangemi, Mariano Oropeza-Aguilar, Bernardo Gabilondo-Pliego, and Francisco T. Rodriguez-Covarrubias Christopher Kauffman-Ortega*Christopher Kauffman-Ortega* More articles by this author , Adrian M. Garza-GangemiAdrian M. Garza-Gangemi More articles by this author , Mariano Oropeza-AguilarMariano Oropeza-Aguilar More articles by this author , Bernardo Gabilondo-PliegoBernardo Gabilondo-Pliego More articles by this author , and Francisco T. Rodriguez-CovarrubiasFrancisco T. Rodriguez-Covarrubias More articles by this author View All Author Informationhttps://doi.org/10.1097/JU.0000000000000914.07AboutPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissionsReprints ShareFacebookLinked InTwitterEmail Abstract INTRODUCTION AND OBJECTIVE: The negative impact of tobacco smoking in renal function has been widely studied. However, there is limited knowledge about the effect of smoking in preoperative and postoperative renal function in living kidney donors. The objective of this study is to evaluate the short and long term impact of smoking on donor renal function. METHODS: Retrospective observational study of prospectively collected data with 2 years follow up of 308 patients who underwent live kidney donation at a tertiary referral hospital in Mexico City. We compared baseline characteristics as well as functional outcomes following live kidney donation according to a past history of tobacco smoking. Estimated glomerular filtration rate (eGFR) was calculated with the Modification of Diet in Renal Disease (MDRD) equation in 6 time periods: preoperative, 1 week, 1 month, 6 months, 12 months and 24 months after surgery. We performed binary logistic regression analysis to identify risk factors associated with chronic kidney disease (CKD) at 24 months of follow up. ROC curve analysis was performed to identify a smoking index cut off point for CKD. Chronic Kidney Disease was defined as eGFR <60 ml/min/1.73m2. RESULTS: Median follow up was 24 months. Among donors, 106 (34.4%) reported a positive smoking history before nephrectomy and 202 (65.6%) had never smoked. Most of the smoking donor group were male (57.5% vs 33.7%, p= 0.00). Renal donors with smoking history had worse preoperative eGFR than non-smokers (90 ± 26.3 ml/min/1.73m2 vs 96 ± 27ml/min/1.73m2, respectively; p=0.02) and lower eGFR at 1 week (p=0.01), 1 month (p=0.00), 6 months (p=0.01) and 12 months (66 ± 25.3 ml/min/1.73m2 vs 74 ± 22ml/min/1.73m2, respectively; p=0.01) after the nephrectomy. At 24 months, no difference was found in the postoperative renal function between both groups. The smoking index cut off point for CKD with AUC 0.67 was 3.2. Smoking history (OR 3.35, p= 0.002) and age above 40 years old at donation (OR 6.59, p= 0.00) were associated with postoperative development of CKD in living renal donors at 24 months. CONCLUSIONS: Living kidney donors with tobacco smoking history require close follow up during the first postoperative year due to the increased risk of developing chronic kidney disease. Smoking cessation strategies should be implemented before and after the nephrectomy. Source of Funding: None © 2020 by American Urological Association Education and Research, Inc.FiguresReferencesRelatedDetails Volume 203Issue Supplement 4April 2020Page: e774-e774 Advertisement Copyright & Permissions© 2020 by American Urological Association Education and Research, Inc.MetricsAuthor Information Christopher Kauffman-Ortega* More articles by this author Adrian M. Garza-Gangemi More articles by this author Mariano Oropeza-Aguilar More articles by this author Bernardo Gabilondo-Pliego More articles by this author Francisco T. Rodriguez-Covarrubias More articles by this author Expand All Advertisement PDF downloadLoading ...

Measurement of effective renal plasma flow using model analysis of dynamic CT in the preoperative evaluation of the renal transplant donors.

Renal scintigraphy is widely used to evaluate residual function of a transplanted kidney from the donor. Dynamic computed tomography (CT) imaging can evaluate both kidney morphology and regional renal function. The aim of this study was to develop an imaging protocol and a calculation method using dynamic CT for assessing the effective renal plasma flow (ERPF) by model analysis, and to evaluate the validity of the obtained ERPF values. Preoperative dynamic CT examination with a low radiation dose exposure system was performed for 25 renal transplant donors, and ERPF was calculated from the obtained images (CT-ERPF). To calculate CT-ERPF, we set the region of interest (ROI) in the renal cortex using automatic ROI-setting software developed in our laboratory. We compared the processing time with automatic and manual ROI settings. To evaluate the validity of CT-ERPF, we examined the correlation of age with CT-ERPF and compared with reported ERPF values. We also compared the uptake rates of technetium-99m-dimercaptosuccinic acid and CT-ERPF in terms of the right-to-left ratio. There was good agreement of CT-ERPF assessed using automatic and manual ROIs. CT-ERPF was negatively correlated with age and showed values below the reference ERPF range in 21 cases. The right-to-left ratio of CT-ERPF showed a significant correlation with that of technetium-99m-dimercaptosuccinic acid. Using our method, CT-ERPF was a useful indicator for preoperative evaluation of donor's renal function.