Living kidney donor transplantation is the preferred treatment for ESRD because it confers excellent outcomes for recipients and poses reasonable risks to donors. Post-donation glomerular filtration rate (GFR) is an important measure because it might relate to long-term donor outcomes. Therefore we studied how donor characteristics associate with post-donation kidney function.

We studied living kidney donors from the national SRTR database between 2008 and 2013 (n=35,758). Baseline, 1- and 2-year post-donation eGFR was available in 17,671 donors which we included in this study. We examined changes in eGFR (based on the CKD-EPI equation) from pre-donation to 1- and 2-years post-donation available on UNOS follow up forms. We utilized multivariable general linear models to estimate the distribution of changes in renal function and independent factors associated with level of change while adjusting for age, race, gender, smoking, HTN, education, marital status, year of donation, BMI, MAP, baseline eGFR, health insurance, work status and kidney reoperation.

The mean absolute donor eGFR prior to donation was 97.9±18.5 ml/min/1.73 m² and was 66.5±16.1 and 67.8 +16.3ml/min/1.73 m² at 1 and 2 years post-donation, respectively. The median percent change in eGFR from baseline to these two time points were -34% (IQR26%-39%) and -33% (IQR 25%-40%). As displayed in the Figure, numerous factors were statistically independently associated with greater declines in post-donation eGFR including older donor age, Caucasians and other donor races versus Hispanic donors, male gender, higher BMI, donors with insurance and those with higher education. Donation in recent years was also independently associated with a more pronounced declined in GFR (2011-2013 vs. 2008-2010). In conclusion, older donors, males and non-Hispanic donors demonstrated larger declines in eGFR following donation. The overall mean percent decline in GFR was 34% during the first year post-donation and slightly lower at 2 years, suggesting that adaptation in the remnant kidney may continue over time.

CITATION INFORMATION: Poggio E, Arrigain S, Augustine J, Flechner S, Schold J. Post-Donation GFR Changes in Living Kidney Donors. Am J Transplant. 2017;17 (suppl 3).

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