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Korean J Transplant 2020; 34(2): 84-91

Published online June 30, 2020

https://doi.org/10.4285/kjt.2020.34.2.84

© The Korean Society for Transplantation

Long-term compensation of renal function after donor nephrectomy

Yong Pyo Lee1 , Soo Jin Kim2,3 , Juhan Lee2,3 , Jae Geun Lee2,3 , Kyu Ha Huh2,3 , Dong Jin Joo2,3 , Soon Il Kim2,3 , Yu Seun Kim2,3 , Myoung Soo Kim2,3

1Department of Medicine, Yonsei University College of Medicine, Seoul, Korea
2Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
3The Research Institute for Transplantation, Yonsei University College of Medicine, Seoul, Korea

Correspondence to: Myoung Soo Kim
Department of Surgery, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
Tel: +82-2-2228-2123
Fax: +82-2-313-8289
E-mail: ysms91@yuhs.ac

Received: April 18, 2019; Revised: February 17, 2020; Accepted: March 20, 2020

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.

Keywords: Glomerular filtration rate, Nephrectomy, Living donors, Kidney transplantation

HIGHLIGHTS
  • The immediate postoperative estimated glomerular filtration rate decreased to about 65.5% of its primary function which is affected by the sex and body mass index of the donor.

  • In the long term, we found that compensation of renal function occurs over time, regardless of donor factors.