Background:It is generally accepted that in living kidney donor nephrectomy for transplantation, the donor should remain with the larger kidney volume if possible. It has been proposed that donor nephron mass is associated with recipient graft function. We thus conversely studied if there is any correlation of remaining kidney volume (RKV) in donors with post-donation residual donor renal function (RRF)

Methods: Retrospective chart review of 184 living kidney donors whose demographics and anthropometrics were analyzed with follow up renal function up to 2 years. Correlation analysis was done with pre-donation radiological evaluation of CT Angiogram based renal volume measurements.

Results:A total of 184 living donors were enrolled in the study. Mean age was 39.4

±11.0, with 67.3% females and 92.3% Whites. Mean CTA based total kidney volume (TKV) was 378±84.0 ml, with mean donated kidney volume of 185±43ml and mean RKV of 193±42 ml. Pre-donation TKV significantly correlated with donor height, weight, BMI, BSA, 24hr Crcl, and MDRD eGFR (p<0.05)but not with donor age. Remaining Kidney Volume was significantly positively associated with a higher eGFR at 6mo, 1yr and 2yr post-donation with mean eGFR of 61.8±14.3, 61.6±14.9, and 62.6 ±16.1 respectively (p<0.05). Donor age did not have any significant correlation with eGFR at any time point or change in eGFR since donation.BSA and BMI were negatively associated with 6mo, 1yr and 2yr eGFR (p<0.05), but not with change in eGFR. RKV adjusted for weight,BSA and BMI showed a stronger incremental significant positive correlation with 6mo, 1yr and 2yr eGFR and inverse negative correlation with serum creatinine at these time points (r=0.34,0.43,0.55; r=0.27,0.36,0.47; r=0.36,0.38.0.49; p<0.05)respectively. Race and gender did not have any effect on RRF nor any association with RKV dependent changes in eGFR. Pre-donation 24hr crCl also had a positive correlation with 2yr eGFR post-donation (p<0.05).

Conclusions: There appears to be a correlation of remaining kidney donor volume with RRF, along with a correlation of anthropometric measures and RRF. As with recipients, remaining nephron mass as measured by a surrogate marker of remaining kidney volume can be a predictor of residual donor renal function. Hence every attempt should be made to leave the donor with the larger volume kidney.

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