Living kidney donation (LKD) needs a careful evaluation of the kidney function of the donor. There are diverging evaluation methods in use. The purpose of this study was to weigh the medical need for radioisotopic kidney function measurement.

Methods: We performed a short enquiry in Eurotransplant (ET) revealing the regional disparities for the evaluation methods. Than we compared in a retrospective study of 167 performed LKD at our center different GFR methods in use with the goldstandard of radioisotopic assessed GFR (DTPA and MAG3). We evaluated the impact of CT-measured renal cortex volume by comparing calculated GFR ratios (cGFR) based on CT-measured renal cortex volume with radioisotopic measured GFR. We compared those cGFR ratios for their suitability to predict kidney function for both, the donor and the recipient.

Results: >90% of the transplant centers in ET are using radioisotopic methods to evaluate the kidney function. Our study showed that predonational correlation with DTPA-measured total GFR showed good correlations with total cortex volume (r=0,67; p<0,000) and estimated GFR(Cockroft Gault) (eGFR (CG) r=0,55; p<0,000). Total cortex volume correlated well with eGFR(CG) (r=0,64; p<0,000) and BSA (r=0,66, p<0,000). The split kidney function for radioisotopic (MAG3) or CT-volumetric proportioning showed excellent correlations with DTPA, eGFR(CG) and cortex volume (r>0,9; p<0,000). The radioisotopic and CT-volumetric cGFR ratios of the preserved kidney showed excellent correlations with eGFR(CG) of the donor 6 months after donation (cGFR(CG)_MAG3 r=0,85; p<0,000 and cGFR(CG)_Cortex% r=0,83; p<0,000). The cGFR ratios of the donated kidney showed good correlations with recipients eGFR(CG) at 6 months (cGFR(CG)_MAG3 r=0,62; p<0,000 and cGFR(CG)_Cortex% r=0,64; p<0,000) and the best eGFR(CG) after transplantation (cGFR(CG)_Cortex% r=0,75; p<0,000 and cGFR(CG)_MAG3 r=0,73; p<0,000)

Conclusion: In a majority of ET radioisotopic measurement of the donor GFR is performed. We showed the usefulness of eGFR(CG) in combination with CT-measured cortex volume for the pre-donational donor evaluation and for the prediction for post-donational kidney function in both, the donor and the recipient.

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