Renal Mass as a Determinant Factor of Long-Term Post-Donation Anemia

S. Shah,¹ B. Lankowsky,² Z. Zaky,¹ S. Nurko,¹ R. Fatica,¹ S. Gebreselassie,¹ B. Stephany,¹ E. Poggio.¹

¹Nephrology and Hypertension, Cleveland Clinic, Cleveland, OH
²Case Western Reserve University, SOM, Cleveland, OH.

Meeting: 2015 American Transplant Congress

Abstract number: B188

Keywords: Kidney transplantation

Session Information

Session Name: Poster Session B: Living Donor Issues 1

Session Type: Poster Session

Date: Sunday, May 3, 2015

Session Time: 5:30pm-6:30pm

Presentation Time: 5:30pm-6:30pm

Location: Exhibit Hall E

Living kidney donors lose approximately 50% of renal mass when donating a kidney however, renal function recovers to within 60-70% of baseline within weeks to months of donation. The kidney is the primary source of erythropoietin (EPO) production, and EPO production declines with declining functional renal mass. We hypothesized that the remaining kidney mass and function following live donation are determinants of hemoglobin (Hb) concentration and therefore post-donation anemia (PDA).

We studied 329 living kidney donors with at least one year of follow up to exclude post surgical acute blood loss. Anemia was defined using the WHO criteria – Hb <12 g/dl in females and Hb <13g/dl in men. Demographic variables, renal function and renal mass were investigated as factors associated with PDA using univariate and multivariate logistical regression analysis. Pre donation donor GFR was measured by ¹²⁵I-iothalamate GFR (iGFR), and post donation donor GFR was calculated using the CKD-EPI equation. Kidney mass was calculated from kidney volumes obtained from 3D CT scans.

The mean donor age was 41±11 yo, 9.5% were African Americans and 42% were males. Median time of follow up from nephrectomy was 446 days (IQR 331-754 days). Anemia was present in 35/328 (10.7%) of donors. Donors with PDA had a mean Hb of 11.4±1.0 vs 14.0±1.1 g/dl (p<0.001) for those with no anemia. The Hb pre-donation was also lower for those with eventual PDA vs those with no PDA (12.8±1.4 vs 14.2±1.2 g/dl (p<0.001)). PDA was more prevalent in female than male (14% vs 5%, p=0.012), but there were no effects as a result of age or race. Donors with PDA had lower post transplant kidney volume adjusted for donor BSA than those with no PDA (170±41 vs 203±58 cc/1.73m², p<0.001). Donors with and without PDA had similar pre-donation GFR (107±18 vs 104±14 ml/min/1.73 m², p=0.190) and post-donation GFR (72±14 vs 68±14 ml/min/1.73 m², p=0.236). In a multivariable logistic regression analysis retained kidney volume and pre-donation Hb but not GFR or female sex remained as independent factors associated with long-term PDA (p=0.020).

In conclusion, the prevalence of PDA beyond one year of donation is approximately 11% and retained renal mass along with pre donation Hb appear to be the most important independent determinant factors.

To cite this abstract in AMA style:

Shah S, Lankowsky B, Zaky Z, Nurko S, Fatica R, Gebreselassie S, Stephany B, Poggio E. Renal Mass as a Determinant Factor of Long-Term Post-Donation Anemia [abstract]. Am J Transplant. 2015; 15 (suppl 3). https://atcmeetingabstracts.com/abstract/renal-mass-as-a-determinant-factor-of-long-term-post-donation-anemia/. Accessed May 17, 2025.

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