Purpose: Living kidney donor outcomes are tremendously important, especially given expanding donor eligibility. Relative to other predictors, the relationship between remaining kidney volume and post-donation renal function is poorly understood.

Methods: We determined associations between remaining kidney volume (via pre-donation CT angiography) indexed to body surface area (BSA) and 1-year post-donation renal function in 152 living kidney donors at an academic center using multivariable linear and logistic regression for continuous eGFR and chronic kidney disease (CKD, eGFR <60 ml/min/1.73m²), respectively.

Results: Mean±SD age, body mass index and baseline eGFR were 38±11 y, 26±4 kg/m² and 97±16 ml/min/1.73m². 50% were male and 94% were white. Median (range) remaining kidney volume/BSA was 79.6 (47.1-114.2) ml/m². Mean baseline (pre-donation) eGFR was greater with increasing tertiles (T1-T3) of remaining kidney volume/BSA (92±14, 97±16 and 107±16 ml/min/1.73m² for T1, T2 and T3, respectively; p<0.001). There were no other significant differences in baseline characteristics by remaining kidney volume/BSA tertiles. As shown in the Figure (panel A), post-donation renal function declined and then remained separated throughout the first year for T1-T3. Panel B shows that the probability for CKD at 1-year increased abruptly for lower remaining kidney volume/BSA in donors with baseline eGFR <90 ml/min/1.73m², remained stable at around 30% regardless of remaining kidney volume/BSA in donors with baseline eGFR 90-100 ml/min/1.73m², and did not increase above 30% unless remaining kidney volume/BSA was <55 ml/m² in donors with baseline eGFR >100 ml/min/1.73m². As shown in panel C, each SD increase in remaining kidney volume/BSA was associated with 2.4 (95% CI: 0.7-4.1) ml/min/1.73m² higher adjusted 1-year eGFR.

Conclusions: In this living donor cohort, remaining kidney volume/BSA was a major determinant for CKD 1 year after nephrectomy in those with baseline eGFR <90 ml/min/1.73m². More studies are needed to evaluate the predictive utility of this clinical measure and its potential role in donor evaluations and informed consent.

CITATION INFORMATION: Hall I., Shaaban A., Beddhu S., Shihab F. Probability of Developing Chronic Kidney Disease 1 Year after Living Donor Nephrectomy Correlates with Baseline Kidney Volume and Function Am J Transplant. 2017;17 (suppl 3).

« Back to 2018 American Transplant Congress