Risk factors and 2 year outcomes of low estimated glomerular filtration rate in the immediate post-operative period for living kidney donors

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Conference Proceeding

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Publication Title

Am J Transplant


Background: While long-term risk of end-stage renal disease in living kidney donors is considered less than 0.25% at 15 years, an association between the immediate post-operative estimated GFR and long-term outcomes after donor nephrectomy remains to be elucidated. Methods: From April 2008 to June 2014, 186 consecutive living kidney donors were retrospectively evaluated. eGFR was calculated using MDRD-4 formula. Statistical analysis was done using logistic regression analysis. Results: The median eGFR on post-operative day 1 (eGFR1) was 51.8mL/ min/1.73m2. Risk factors for eGFR1<50mL/min/1.73m2 were age>50years (OR 5.31; p=0.0004) and pre-operative eGFR <100mL/min/1.73m2 (OR 9.96; p<0.0001). Protective factors for loss in eGFR<40% post donation were female sex (p=0.001) and lower pre-operative creatinine (p<0.0001) (Table presented). Correlation between post-op creatinine and creatinine at 2 years (n=114) was strongly positive (r=0.692; p<0.0001). Older age (p=0.002) was the only independent risk factor for higher loss of renal function at 2 years (LRF2y>50%). Median recovery of eGFR at 2 years (RRF2y) was 17% of the pre-eGFR. Higher age was an independent risk factor for RRF2y<15% (p=0.001) after multivariate analysis. Conclusions: Older donors (>50y) may have higher risk for renal dysfunction after nephrectomy and poorer long-term recovery, compared to younger donors. Older donors with pre-donation eGFR less than 100mL/min/1.73m2 should be used with caution.



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